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DISEASES

OF THE

HEART AND LUNGS,

THEIR PHYSICAL DIAGNOSIS,

AND

HOMOEOPATHIC AND HYGIENIC TREATMENT.

GEORGE WILD, M.D.,

FORMERLY PHYSICIAN TO THE HAHNEMANN HOSPITAL, AND THE
LONDON HOMCEOPATHIC HOSPITAL.

LONDON:

LEATH & ROSS, 5, ST. PAUL’S CHURCHYARD ;

AND

9, YERE STREET, OXFORD STREET.

LEAMINGTON:

LEATH AND WOOLCOTT, 18, LOWER PARADE.

1860.

li Oo I'CO

J‘. K. Al) LA HI), PHlNTEll, BAltTHOLOMEW CI'OSK.

PREFACE.

Practically — homoeopathy consists in the treatment
of diseases by medicines directly specific to the diseases
treated, and given in doses which experience proves to
be sufficiently large for the chronic or acute affection
present, yet sufficiently minute not to cause any injury
to the vital force, functions, or organic tissues of the
subjects under treatment.

The two great barriers to the universal acceptance of
homoeopathy have been, 1st, over-enthusiastic theorizing
regarding “ the law of cure,” and 2d, the too promi-
nent assertion of the exclusive and absolute sufficiency
of the infinitesimal dose.

For while there is no homoeopathist who does not
believe that the rule similia similibus curantur has a
wider application than any rule ever given for the ad-
ministration of drugs, or who does not know that the
infinitesimal dose will often succeed in effecting cures
after both minute and large doses of crude drugs have
failed ; yet there are few who are not aware that the
converse of this is equally true, and that doses ex-
tremely minute, as compared with allopathic doses, yet
sufficiently large to be cognizable by the senses, have

PREFACE.

often cured diseases which have apparently been unaf-
fected, or it may be aggravated, by high infinitesimals.

From these facts I conclude, that although it is our
duty to use such doses as we believe to be best for the
case in hand, yet if we can conscientiously use doses
palpable to the senses, we shall, by so doing, remove
the main obstacle to the universal acceptance of a sys-
tem of gentle medication, as opposed to that violent or
coarse treatment recommended in the schools, and — to
the infinite injury of the human race — almost univer-
sally practised in the world.

In England and America there are probably not
fewer than two thousand educated medical men prac-
tising on the homoeopathic method. This is a proof,
not only of the substantial position to which our system
has attained, but it would seem also to indicate that the
time has now arrived when homoeopathic practitioners
should take up, and as far as possible render themselves
masters of, specialities.

Homoeopathic literature contains a multitude of
domestic and other guides to the practice of the system,
but, so far as I know, it does not contain any work
specially devoted to the consideration of the diseases of
the Heart and Lungs, although we have special treatises
on various other diseases. Yet about one-third of the
inhabitants of Europe and America die of diseases of
the heart and lungs, — a fact which renders it not unfitting
that an attempt should be made to supply this defi-
ciency.

The following table will show the numbers who have

PREFACE.

died from the diseases treated of in this volume in
England in 1854,* and in London in 1858 and 1859.

Deaths — England and Wales, 1854.

London, 1858.^

London, 1859.

Hooping-cough

11,200

2,700

1,741

Croup

3,660

557

396

Diphtheria ....

(?)

(?) 1,200

Bronchitis ....

22,391

6,388

4,974

Pleurisy ....

856

138

147

Pneumonia . . . .

24,098

4,150

3,076

Asthma ....

5,143

586

517

Phthisis ....

54,918

7,369

7,670

Pericarditis ....

561

122

117

Aneurism ....

315

Diseases of the Heart

12,869

2,313

2,468

Total deaths from diseases of!

the Heart and Lungs . . /

136,011

25,609

22,400

Total deaths from all diseases .

437,000

63,882

61,617

There are no diseases in which the opinion of a second
physician is more frequently sought than in diseases of
the chest ; and I believe every practitioner of homoeo-
pathy has often regretted that he had no access to

* Being pressed for time, I have not been able to ascertain the returns
from England and Wales later than 1854. The above table is compiled
direct from the Registrar-General’s reports; it is, therefore, quite reliable.
The mortality from phthisis is shown to be 12 per cent, of the total
annual mortality; not 20 per cent., as quoted in the body of this book.
If, however, all scrofulous diseases be added together, viz., phthisis, tabes,
hydrocephalus, &c., the mortality from this order of diseases is about
17 per cent, of the total mortality.

Diphtheria is marked (?), as the Registrar-General, in his annual
report, classes this disease with scarlatina, and does not state the annual
Biortality from diphtheria.

PREFACE.

“ chest doctors ” of the opposition school, from whom
he might have an opinion, not as to drug treatment,
hut as to the pathology and prognosis of difficult cases.
It is well known, however, that physicians of the old
school, full of “ pomp and circumstance/* will not meet
us in consultation, even although the question be one
purely of pathology. These men appear sadly to neg-
lect the object of their calling, and prefer standing to
their order, to bending to listen to or instruct those of
their brethren who, differing from them in the
principles of medicine, yet seek the aid of their enlarged
pathological experience, drawn from hospitals or other
sources.

No doubt the day is not far distant when this illiberal
and purblind policy will be despised by all good men ;
but in the meantime the prejudice and the exclusiveness
exist, and it therefore becomes the imperative duty of
every practitioner of homoeopathy so to master his
subject as to render himself independent of the so-called
(< scientific ** consultation physicians.

Some years ago I sought the opinion of a physician
of high standing, in a matter of prognosis, in the case
of a relative of my own, then on her death- bed ; but
this physician, although personally we had been long
known to each other, declined to assist me with the
result of his knowledge and experience. To this same
physician I some years afterwards sent a poor woman
for his opinion. She, a dying woman, staggered up to him
in the wards of the hospital ; but no sooner had she
mentioned that she had been under homoeopathic treat-

PREFACE.

ment than he laughed her tq scorn, before his whole
class of students, calling out their laughter also, and
turning on his heel, refused to ask her one single
question. If this was not barbarity, what is? And
yet this was one of the first physicians of the day,
and one of the most enlightened.

It was this conduct which first suggested to me the
necessity of rendering myself, as far as 1 possibly could,
master of the physical diagnosis and history of diseases
of the chest ; and this book is the result : and I repeat,
homoeopathists must in the meantime render themselves
independent of such men, by devoting themselves more
than they have hitherto done to specialities, and by
endeavouring as far as possible to master given subjects.

While on this matter, I may suggest that there ap-
pears to be a want of a work on the physical diagnosis
and homoeopathic treatment of organic diseases of
the abdomen.

In this volume I have given for each disease a brief
outline of the old-school treatment, drawn from the
most recent authorities. I have done this for two
reasons; 1st, to show what that treatment really is, as
there exists often much ignorance on this head, it being
almost invariably replied to us when we denounce
severe measures, “ Oh, such practices have long been
given up.” It is true that homoeopathy has most
materially modified the practice of medicine generally,
and especially because most allopathic patients, knowing
something of homoeopathy, positively refuse to swallow
all which their medical attendant would thrust upon

YU1

PREFACE.

them. Still I confess, I was not prepared to find that,
even in the most recent and “ scientific ” works, heroic
measures are still quite in vogue. 2d. While the mere
enumeration of the drugs given by the allopatliists may
occasionally suggest a remedy to be tried on a different
scale, the description of the remedies recommended will
generally tend still further to confirm the. homoeopathist
in his safer, milder, and more searching medication ; a
confirmation which he might not at all times find, if, in
his ignorance of modern practice, he suspected that
there were in the possession of the opposition school
possibly some good remedies, with which he was
unacquainted.

In treating of the physiology of the Heart and Lungs,
I have ventured to express opinions differing from those
generally taught as to the office the heart performs in
circulating the blood, and the office the lungs perform
in the acts of respiration.

I have given in the appendix my reasons for advocating
the use of the Turkish bath in health and disease ;
especially in reference to the diseases of the heart and
lungs.

I have entered minutely and fully into the principles
of physical diagnosis — without an exact knowledge of
which no one can pretend to give a trustworthy opinion
in any obscure case of chest disease.

I have devoted much space to the subject of the pre-
vention and cure of disease by hygienic means.

It is a disgrace to this country that there exist no
chairs of hygiene in our schools of medicine. Did such

PREFACE.

exist, there can be little doubt that, long ere this, the at-
tention of medical men would have been drawn to the
powers of nature, and of mild remedies, in the cure of the
most acute diseases ; and much of that atrocious practice,
called active treatment, would have been long since uni-
versally condemned and abolished.

The highest destination of medicine is not to heal
diseases, but so to instruct the world that disease may
become not the rule, but the exception, and that many
of those diseases which now either kill or maim for
life may become extinct.

The homoeopathic practitioner may be disappointed
in finding the list of medicinal remedies here recom*
mended so limited, and in the absence of minute rules
for their administration. But, in the first place, the
diseases treated of are not of that class which calls for a
wide range of remedies ; and, in the second place, the
minute rules for the administration of the remedies
(even if I "fully relied on the possibility of attaining
such) are given in our works on Materia Medica with
a minuteness which it would be impossible in the limits
of this volume to emulate.

I have endeavoured to give the fullest information
regarding the diseases treated of, in the fewest possible
words — more in the form of an epitome than an ex-
tended treatise ; and consequently the reader may often
find the style, if not obscure, at least somewhat cramped
and unpolished. As there exists no homoeopathic work
devoted especially to diseases of the Heart and Lungs,
I have not had the advantage of any homoeopathic

PREFACE.

model to guide me. The execution of this volume —
in which extreme accuracy has been attempted, has not
been an easy task. No one can he more aware of its
imperfections than myself; and no one will more cordially
welcome any criticisms which — administered with the
intention of giving light, may enable me to render
some future edition less imperfect.

I have only to add, that in the composition of this
work I have been much indebted to information de-
rived, especially, from the justly celebrated Laennec,
the analysing and inexorable Louis, the practical and
sensible Stokes, from the broad views of Sir James
Clarke and Dr. Combe, and especially from the exact
and minute information conveyed in the work of Dr.
Walslie, and also from the numerous excellent papers
scattered through the ‘ British Homoeopathic Journal5
and the f American Quarterly Homoeopathic Journal.5

12, Great Cumberland Street,
Hyde Park.

CONTENTS.

PAGE

The Heart akd its Functions . . .1

The Physical Examination of the Heart . . 6

Percussion of the Heart . . . .9

Auscultation of the Heart . . . . 10

Organic Murmurs . . . .11

Inorganic Murmurs . . . . . 16

Pericardial Friction Sounds . . .19

Physical Signs of the Arteries and Veins . . 21

Diseases of the Heart . . . .23

Palpitations . . . , . 25

Syncope . . . . .28

Angiua Pectoris . . . 32

Acute Pericarditis . . . .35

Chronic Pericarditis . . 46

Acute Endocarditis . . . .48

Acute Carditis . . . . . 51

Cardiac Haemorrhages . . . .52

Dropsy of the Pericardium . . . . 52

Atrophy of the Heart . . . .53

Hypertrophy of the Heart . . . . 54

Dilatation of the Heart . . . .60

Distension of parts of the Heart . . . 60

Softening of the Heart . . . .65

Induration of tho Heart . . . 66

Fatty Accumulations about the Heart . . 67

Fatty Degeneration of the Heart . . . 69

Xll

CONTENTS.

PAGE

Diseases of the Heart (continued) —

Tubercle in the Heart . . . .72

Cancer „ . . . . 72

Entozoa „ . . . .72

Diseases of the Valves . . . . 73

General diagnosis of Valvular disease . .78

Cyanosis . . . . 85

Rupture of the Heart . . . .80

Aneurismal Dilatation of the Heart . . . 88

Coagula in the Heart . . . .89

Diseases of the Aorta . . 90

Pulsating Aorta . • . _ . .90

Acute Aortitis .. . . 91

Atheromatous deposits in the Aorta . . 92

Constriction of the Aorta . . 93

Aneurism of the Aorta . . . .94

Abdominal Aneurism . . . 105

Recapitulation ..... 107

The Lungs — their Eunctions . . . . 108

Physical Examination of the Lungs . . .114

Inspection of the Chest . . . . 117

Application of the Hand . . . .121

Mensuration of the Chest . . . 122

Percussion „ . . . 125

Auscultation „ . . . . 131

Resonance of the Voice .... 145
Summary . . .. . 149

Diseases of the Lungs —

Pleurodynia . . . . . 153

Intercostal Neuralgia . . . .154

Neuritis . . . . . 156

Acute Bronchitis . . . .156

Chronic Bronchitis . . . . 162

Hay Asthma . . . . .168

Influenza . . . . . . 169

Hooping-cough .... 171

Asthma . . . . . . 174

CONTEXTS.

Diseases of the Lungs (continued)—
Acute Pleurisy

Diagnosis of Acute and Chronic Pleurisy
Pulsating Empyema
Hydrothorax
Pneumothorax .

Hsemothorax
Acute Pneumonia
Chronic Pneumonia .

(Edema of the Lungs

Gangrene of the Lungs

Htemoptysis

Pulmonary Apoplexy

Atrophy of the Lungs

Vesicular Emphysema

Croup

Diphtheria

Phthisis

Bronchial Phthisis .

Appendix :

Ventilation of Dwellings .

Cough

Climate

The Turkish Bath

xiii

PACK

178

1S3

184

189

191

205

206
207
209

215

216
217
222
227
240
291

294

299

302

306

ERRATA.

Page

■ 8,

line 31,

read Constrictive disease.

11,

First sound of heart is best heard below
and within left nipple.

17,

third interspace.

18,

2-1,

prominently (not promptly).

31,

16,

syncope from.

31,

25,

Dr. Hiring.

75,

23,

Thin blood.

91,

12,

Diet attended to.

91,

22,

Drugs (not drops).

115,

23,

Laenncc died 1826.

136,

Entire lungs.

143,

Tf/ionchus (not bronchus).

DESCRIPTION OF DIAGRAM, &c.

The drawing and diagram on tlie next page represent a man in whom the
clavicles and tlie abdominal arch are well pronounced, and in whom the lungs
are moderately inflated; and are meant to show the form and position of the
lungs, heart, blood-vessels, and main bronchi; the position of the valves of the
heart, and also the relative position of the stomach and the liver to the heart
and lungs.

The position of the heart and lungs in health, varies somewhat with full
inspiration and expiration, the heart being pressed somewhat downwards on full
inspiration.

The heart is about two thirds covered by the lungs.

The base of the heart lies behind the third cartilages, and posteriorly corresponds
with the sixth vertebra.

The apex points below the fifth left rib, below and within the nipple.

The greatest width of the heart lies in a line beginning below and witlun the left
nipple, and extending to a finger’s breadth on the right of the sternum.

The right auricle a lies below the third and fourth cartilages.

The left auricle a a trifle higher on the left side.

The pulmonary semilunar valves b lie opposite the inner edge of the third left
cartilage.

The aortic valves c a little lower on the right side, and about half an inch further
inwards.

The tricuspid and mitral valves d lie side by side at mid-sternum on a fine with
the third interspace, the tricuspid being in front of the mitral valve.

A. half-crown piece would by its circumference cover portions of all these valves,
which are maiuly opposite the mid-sternum, occupying a position which may be called
the centre of gravity of the heart.

The ascending aorta e crosses the trachea at its bifurcation, viz., behind the sternum,
on a hue with the second intercostal spaces.

The transverse portion of the aorta lies behind the sternal notch.

The right bronchus h lies deep-seated below7 the second, cartilage.

The left bronchus li lies somew'liat lower on the other side.

The aorta reaches the spine at the third dorsal vertebra.

The pulmonary artery / bifurcates opposite the second cartilages.

The innominate artery lies behind t lie innominate veins, and bifurcates at the right
sterno-clavicular joint.

The aortic valve sounds are distinguished best at e, viz., at the second right
cartilage.

The pulmonary valve sounds are distinguished best at f viz., at the second left
cartilage.

The second sound of the heart, viz., the united sounds produced by the closing
of the pulmonary and aortic valves, is heard best at mid-sternum, viz., on a" line with the
third intercostal spaces.

The morbid tricuspid valve sounds are distinguished best a little below d, viz., a
‘ little above the ensiform cartilage.

The morbid mitral valve sounds are distinguished best uear the left apex of the
heart.

The sub-clavian arteries and veins lie at gg.

The superior vena cava i lies close to the ascending aortic arch, viz., close to the
right edge of the upper third of the sternum.

The apices of the lungs on full inspiration reach a little above the inner third of
the clavicles, and are in juxtaposition with the sub-clavian arteries and veins.

The base of the lungs anteriorly is on a level with the sixth rib.

The base of the upper lobe of the left lung anteriorly is on a level with the
fourth rib.

Posteriorly the bases of the lungs reach the eleventh ribs, below7 which, on the
right side, lies the liver; on the left side, posteriorly, the intestines; and laterally, the
spleen.

The main bronchi and bronchial glands lie posteriorly between the scapulae.

The ductus arteriosus existed at e, viz., opposite the second left cartilage.

The foramen ovale existed about mid-sternum, viz., a little above the auriculo-
ventricular valves at d.

The chest is for facility in description usually divided into the following regions, viz ,
the anterior, posterior, and lateral, comprehending the sup a-clavicular, the clavicular,
the sub-clavicular, the mammary, the upper, middle, and lower sternal, the axillary,
the sub-axillary, the upper, middle, and lower scapular, the inter-scapular, and sub-
scapular.

THE HEART AND ITS FUNCTIONS.

The human heart of each individual, in size, and in
sli ape also, has a considerable resemblance to the closed
fist of that individual. In woman, it weighs from
eight to ten ounces, and in man, from ten to twelve
ounces. It is suspended by the aorta, which, running
up the left side of the spine, arches forwards and to the
right. It is enclosed in the pericardium, which above
is attached to the aorta, and below is broadly attached
to the diaphragm. The pericardium is a fibrous bag,
with a serous lining, and serves the purpose of support-
ing, keeping in its place, lubricating and protecting
that vital organ, the heart. The heart rests on its pos-
terior flat surface on the diaphragm.

Anatomically, the heart occupies a position between
the right and the left lungs, as near to the centre of the
chest as the form of the lungs and its own liberty of
action will permit. Poetically, the heart is the central
organ of the affections, emotions, and passions of man.
Philosophically, the action of the heart is the type of
the universal law of creation — in attracting and pro-
pelling, viz , in circulating the vital blood.

TIIE HEART AND ITS FUNCTIONS.

The right side of the heart has to deal only with
venous blood ; the left side with arterial blood.

In the early embryo, the heart is merely a pulsating
dilatation of the vascular system.

In the matured heart, the right side may be regarded
as a development of the venous system, and the left
as a development of the arterial system.

The pericardium is the correspondent of the cellulo-
fibrous sheath of the blood-vessels; the endocardium
corresponds to their lining membrane, while the muscular
tissue of the heart is represented by the elastic quasi-
muscular coat, common to both arteries and veins,
although only moderately developed in the veins.

The muscular fibres of the heart are said to be involun-
tary, yet striated imperfectly, like voluntary muscles ;
but is the heart totally an involuntary muscle, or is its
action not considerably under the control of the will ?

Although Servetus (who was martyred by Calvin, in
1553) appears to have believed in the circulation of the
blood through the lungs, yet the entire mechanism of
the circulation of the blood was discovered and demon-
strated for the first time by Harvey, in 1620.

Physiologists teach that the ventricles, by the power
of their contraction (systole, avartWio, to contract) alone
are the efficient causes of the circulation of the blood.
This doctrine has always appeared to me to be most erro-
neous. The ventricles have a power of dilatation (dia-
stole, <haerreAAa>, to separate), even out of the body, so
powerful, as to overcome forcible manual pressure.
The ventricles, after having expelled the blood into the
arteries, immediately begin to dilate, and thus form
two vacuum-cavities, when, according to the law of
hydraulics, the blood in the veins is drawn through to

THE HEART AND ITS FUNCTIONS.

fill up the vacuum ; while the blood will pass through
the capillaries by virtue of capillary attraction, aided
no doubt, by the suction power of the diastole. To
assert that the systolic action is sufficient to propel the
blood through the capillaries, and thence up the pon-
derous ascending vena cava, and also sufficient to pro-
pel the blood of the portal vein through the liver, and
thence up into the ascending cava, is manifestly, to my
mind, a singular hallucination. The circulation of the
portal blood through the liver must be aided by the
suction power of the diastole ; but I also believe that
the liver and other organs have their independent vital
attraction for the blood, irrespective of the action of
the heart.

Can the advocates of the propulsive power of the heart
as alone sufficient, assert that this power is sufficient to
drive the maternal blood through the placenta and along
the tortuous umbilical cord ; and that the foetal heart
has power to return this blood, not only through its own
venous system, but back again to the mother by pro-
pulsion only ? Or can it be for a moment granted that,
in extraordinary cases, such as the one mentioned by
Dr. Stokes, p. 153 of his work on f Diseases of the
Heart/ where stricture of the aortic valve was carried
to an extent so great, that the stricture could admit
only a small probe — the systolic power alone is suffi-
cient to complete the circuit of the general and
hepatic circulation?

The hissing rush and instantaneous death resulting
from the accidental entrance of air into an opened vein,
is, no doubt, caused by the right ventricle being filled
with air, and thus ceasing to be a suction pump, so that
death results from syncope. The further fact that, after

THE HEART AND ITS FUNCTIONS.

death, the main arteries are found more or less empty,
giving rise to the idea among the ancients, until the
days of Galen, that they were air-vessels, hence the
term arteries, while the veins are gorged with blood, is
to my mind an absolute proof that the arteries have
been emptied, not by the vis a ter cjo, but that the veins
are gorged by the suction (diastolic) power of the heart.

The auricles may be regarded as dilated pouches,
or supply cisterns for the ventricles.

The left ventricle, having the chief labour of sus-
taining the circulation, contains about three times
the bulk of muscular fibres possessed by the right ven-
tricle.

The valves of the heart are of a tendinous structure,
and covered with duplicatures of the endocardium.

The inner walls of the ventricles are braced or com-
posed of columnse carneae, from which arise the papil-
lary muscles, from which again arise the tendinous
cords, which brace the great auriculo-ventricular valves.
The tricuspid valve prevents regurgitation into the
right auricle, the bicuspid or mitral valve prevents
regurgitation into the left auricle, while semi-lunar
valves, each composed of three lips, prevent regurgi-
tation from the aorta and the pulmonary arteries.

The heart in its action produces two sounds; the first
synchronous with the pulse, and therefore with the
contraction of the ventricles, the closure of the bicuspid
and tricuspid valves, the rush of the blood along the
vessels, and the beat of the heart against the chest
walls, and the tightening and vibration of the chordae
tending attached to the bicuspid and tricuspid valves ;
the second sound immediately follows the first, and is,
therefore, synchronous with the closure of the valves of

THE HEART AND ITS FUNCTIONS.

the aorta and the pulmonary artery, with the recoil of
the column of blood from the aorta and pulmonary
artery on the aortic and pulmonary valves, together
with the fall of the auricular blood into the ventricles ;
and, notwithstanding the mystery sometimes made in
tins matter, it must be evident that the two sounds
cannot be from any other causes than tlie phenomena
just described, as synchronous with these sounds.
Broadly speaking, the first is a sound of propulsion —
the second, a sound of arrestment.

Physiologists teach that the tilting up of tlie heart’s
apex, synchronous with the contraction of the ventricles,
arises from the manner in wrhich the fibres of the heart
are arranged, — a singular theory, which, if true, would
hold good if the heart were artificially suspended out of
the body, so long as the ventricles contracted. To me it
has always appeared manifest, that the tilting of the
heart arose from the propulsion of the blood against
the elastic roof of the aortic arch, wrhen, according
to the simplest mechanical contrivance, the tilting of
the heart must follow — the object, on nature’s part,
evidently being to bring the long axis of the left
ventricle into an approaching parallelism with the
aortic arch, so as to present the least possible resistance
to the flow of the blood.

The frequency of the hearts’ action gradually
diminishes from the commencement to the end of life.
Muller states it as follows :

In the embryo the number of beats in a
minute is .

Immediately after birth
During first year
During the second year

150

130 to 140
115 — 130
100 — 115

THE HEART AND ITS FUNCTIONS.

During the third year .
About the seventh year
About the fourteenth year
In the middle period of life .
In old age

90 to 100
85 — 90
80— 85
70— 75
50 — 05

In those of an excitable temperament the pulse is
more frequent than in the phlegm atic, and more frequent,
perhaps somewhat in the ratio of 80 to 70, in the
female. It also has increased frequency if the indi-
vidual be in a rare atmosphere, as on high mountains.

Dr. A. T. Thompson was in the habit of stating in
his class that the habitual pulse of Napoleon the First
was only 40. This was, however, I suppose, only
during his lethargic life at St. Helena, and after the
heart had become fatty.

In hysteria the pulse, in relation to the number of
respirations, may be as 5 to 1, or the reverse, as 1 to 5 ;
and in pneumonia there may be five respirations to each
pulsation.

THE PHYSICAL EXAMINATION 0E THE HEART IN
HEALTH AND DISEASE.

By the above title is meant that examination of the
chest by inspection, touch, auscultation and percussion, by
which processes, singly or collectively, we can ascertain
the size and position of the heart, and the position and
sounds of the valves in health and in disease.

In the first place, it is necessary to know the exact
normal position of the heart, and this I have endea-
voured to delineate and describe in the diagram
and letterpress at the beginning of this volume.

In the normal condition of the heart and of the

rilYSICAL EXAMINATION.

chest, there is no external indication of the locality of
the heart, except the beat of the apex below the fifth
left rib, both sides of the chest being symmetrical in
form. In health, the beat of the heart, below the fifth
rib, may be imperceptible to the eye or to the hand, in
quiet action or in the corpulent. The position of this
beat may be raised by flatulent distension of the
stomach, pregnancy or ascites, or concealed or altered
by emphysematous lungs, hydrothorax and pericardial
effusion, altering the position of the heart upwards or
downwards. Also in enlargement of the heart the apex
beat is lower than normal. Muscular action and
mental excitement much increase the force of the beat ;
and that mental excitement especially, which more or
less is experienced by all patients who present them-
selves for examination of the chest, must of course be
borne in mind by the physician.

The cardiac region is bulged forwards in hypertrophy
of the organ, in pericardial effusion if to a considerable
amount, and mediastinal tumours may also cause
bulging. On the other hand, the region may become
depressed after pericarditis, owing to subjacent fibrous
contractions and adhesions.

The normal position of the nipples of the breast is
symmetrical, but bulging in the cardiac region will to
some extent alter the relative position of the left nipple
with reference to the sternum or the clavicle, such
differences being more appreciable to the eye than by
tape measurement. But this alteration in relative
position can be produced by spinal curvature or in-
equality in the form of the ribs, or by mere unsymme-
trical muscular development.

Occasionally a wavy sensation is produced by the

TIIE HEART.

systolic action of the heart in copious pericardial effu-
sions, while a pseudo wavy sensation may be produced
by that kind of flabby enlargement in which the heart
loses that compact control over itself and over its con-
tained blood which exists in the healthy organ.

A heart much dilated, but not sufficiently hyper-
trophous to cause energetic contraction, or a large
fatty heart, will not beat against the fifth rib, but
merely with a lethargic movement rise bodily against
the chest-walls. That double systolic impulse some-
times occurring when the organ is much dilated, appears
to me to arise from a renewed effort of the ventricles to
expel their contents — an act which must be difficult
where we have a large cavity contracting on a limited
bulk of blood.

So also in incompetency of the mitral valve and
regurgitation into the left auricle, the left ventricle
often makes double contractions, from what appears to
me to be a quasi-instinctive knowledge on the part of
the organ that sufficient blood has not been propelled
into circulation. This double contraction on the part of
the ventricle also may occur in aortic regurgitation, from
a like desire to propel forwards that blood which has
regurgitated from the aorta.

But irregularity in the rhythm and in the force of
the heart’s contractions is a frequent occurrence in
dyspepsia, flatulence, hysteria, or mere nervousness.

A vibratory tremor may occur, if the force of the heart
be in excess of the facility with which the blood can
escape on ventricular contraction ; hence, it is a fre-
quent occurrence in aortic constructive disease.

In sthenic palpitations, occurring in those whose
blood is what is called thin (spansemic or anaemic), this

PERCUSSION.

vibratory thrill may occur. In mechanical motion, we
have a frequent illustration of this vibratory tremor in
the instance of small steamboats, propelled by engines
disproportionably strong, or when steamers make head
against strongly opposing currents of water.

PERCUSSION OF THE HEART.

By percussion, the size and position of the heart can
be determined with much nicety. The normal position
is given in the diagram at the beginning of this volume ;
and in percussing, it is necessary to keep in mind the
position of the aorta, so as not to include dullness pro-
duced by that vessel in delineating the size of the
heart. The diagram shows the position of the aorta,
and also to what extent the heart is overlapped by the
lungs, the percussion over which must be somewhat
more emphatic, in order to bring out the dullness pro-
duced by the subjacent heart.

"Where exactness is required, the patient should be
in the recumbent position, and the extreme limits of
the dullness can be, for convenience in measuring the
size, marked lightly on the chest with a pen and ink.

The diagram shows the position of the heart in
relation to the stomach and the liver. The liver of the
adult, if much enlarged, may extend as far as the
heart. The stomach, if indurated by cancerous
deposit, or distended by gas, by encroaching on the
precordial region, may interfere with the percussion
sounds at the heart's apex. An emphysematous state
of the lungs, causing much overlapping, or, on the
other hand, condensation of the edges of the lungs,
with or without retraction of the lungs, may also inter-

TIIE HEART.

fere with the easy delineation of the limits of cardiac
dullness. The presence of aneurism of the aorta,
or of mediastinal tumor, or fatty deposit, may also
mislead.

The main object of percussion in the cardiac region, is
to ascertain the presence or absence of hypertrophy of the
heart; or of pericardial effusion. The history of the case
Avill usually be sufficient to enable us to distinguish
between these two diseases, when increased precordial
dullness is discovered. The dullness should be increased
in the lower part of the region when the patient sits up,
if from the gravitation of fluid — although a considerable
accumulation of fluid, and an enlarged, flabby, and
weak heart, will furnish closely approximating physical
signs. The fact that, of all percussion sounds, that
produced over fluid is the most dead, while it is less
resistent than that experienced over solids, null aid in
cases of difficult diagnosis. Time or successful treatment
may further be expected to diminish the extent of fluid
percussion dullness, but not, except in rare cases or after
a long time, that of dullness from excentric hyper-
trophy.

Further, a large, flabby heart will yield a very im-
perfect first sound, but if the presence of effusion be
the only abnormal condition, the first and second
sounds, although somewhat obscured, it may be, by the
fluid present, will yet be pure in character.

AUSCULTATION OF THE HEART.

Auscultation of the heart, when minuteness is
necessary, must be performed with the stethoscope, as

AUSCULTATION.

the ear cannot be immediately applied with that exact-
ness as to locality which is necessary in making exami-
nations as to the condition of the different valves. It
may be necessary to cause the patient to hold his breath
where there are abnormal lung sounds, which might
interfere with an exact appreciation of the character of
feeble heart sounds.

I have already given the cause of the two sounds of
the heart. The first sound has a prolonged, booming,
vibratory character, and is best heard above the fifth
rib, in a direct line below the nipple (see diagram),
viz., over the left Arentricle, which is the stronger in
action — the right ventricular sound being better heard
at the end of the sternum.

The second sound is shorter and more abrupt, and is
best heard at mid- sternum, viz., on the level of the
second intercostal space — over the seat of the valves
of the aorta and pulmonary artery.

As a rule, the sounds of the heart are clearer in
character in women and children than in men, and are
evidently clear in proportion to the compact vigour
and tonicity of the organ. Inflammatory, but espe-
cially hysterical and nervous excitement, by increasing
the rapidity and force of the heart’s action, sometimes
greatly intensify the first sound, and hence the necessity
of deliberation and quietness of observation. On the
other hand, general debility, or weakening organic
diseases, or fatty degeneration, or a flabby condition of
the organ, or dilatation, all weaken the first sound
especially — and in cases of excessive debility, it may be
necessary to excite the patient, so as to rouse up the
heart into an audible expression of its sounds.

THE HEART.

General hypertrophy, and excentric hypertrophy also,
so long as with the last there he, with increased ventri-
cular cavity, sufficient contractile force in the ventri-
cular walls, yield increased sounds.

But in concentric hypertrophy, the ventricular cavity
may he so small and contain so little blood, and there
may remain so little room for ventricular contraction, and
so little blood to propel, that both sounds may be much
reduced in intensity — and even in extreme cases, become
almost inaudible. In general hypertrophy also, where
the valves participate in the general thickening, there
must be less vibratory action, and therefore both sounds
are proportionally blunted. Hypertrophy, by lowering
the apex will alter the position of maximum first
sound ; so also will pleuritic effusions. Fluid or gas
in the pericardium will obscure the heart-sounds, and
fluid, by floating up the heart, will alter the normal
locality of the sounds ; but agglutination of the pericar-
dium to the chest-walls, by bringing the heart nearer to
the surface, or induration deposits, by increasing the
power of transmission, will tend to intensify the sounds.
The stomach distended with gas has been known to echo
the hearths sounds.

Soft thickening of the aortic valves will diminish the
clearness of the second sound, and so also will any loss
of elasticity in the aorta, by closing the aortic valves less
sharply.

As the ventricles instinctively wait until sufficiently
filled with blood before they contract, any impediment
to their filing, as sluggish circulation, or mitral obstruc-
tion, will delay the contraction. If this hold true, and
if there were mitral obstruction, but not tricuspid

AUSCULTATION.

obstruction, then theoretically there should be a want of
unison in the contraction of the right and left ventri-
cles; but 1 am not aware that observation has ever
verified such a coincident result.

Slight murmur-like” sounds may be produced by
any temporary vascular roughening of the valvular
orifices, as may occur in acute rheumatism not pro-
ceeding to permanent valvular deposit.

In a state of peaceful quiescence of mind and body,
a strong heart may contract so quietly and deliberately
as to yield very little first sound.

The pulse at the wrist should be synchronous with the
contraction of the ventricles, but it may be behind time
if there be incompetency of the aortic valves, or perhaps
if there be a flabby, inelastic condition of the aorta, or
the heart’s propulsive power be feeble. There may also
be instances of two beats of the heart to one at the
wrist, the first contraction of the ventricle being feeble,
or if there be regurgitation by the mitral valve, or if
the ventricle at the first beat contain little or no
blood.

Irregularity or intermission in the contractions of
the heart, may be from an hysterical or nervous habit ;
it also exists with a feeble heart or fatty heart. The
character of the contractions may be that of a delayed,
lazy, action, or there may be two or three slow contrac-
tions, and then perhaps three galloping contractions to
make up, as it were, lost wray. In merely nervous
irregularity, the sounds should be nearly normal, but
in irregularity from softening or weakness, the sounds
will have a corresponding deficiency in clearness. Fur-
ther, if there be mitral obstruction to the circulation,
there will be intermissions and variations in fulness

TIIE HEART.

in tlie pulse, as the ventricle will sometimes, but not
always, wait, as it were, on its proper stimulation to
contraction, viz., its being filled with blood.

Reduplication, or repetition of the first or second
sound, or of both, is occasionally observed ; that is, each
sound is supplemented, as it were, by a minor repetition
of itself. It has been suggested that reduplication of
the first sound may arise from a want of synchronism
between the contractions of the left and right ventricles.
It appears to me that it may also sometimes be caused
when the first contraction of the ventricle, not having
succeeded in expelling all its contents, a supplemental
contraction is excited ; in this case there would also
be a repetition of the second sound ; or, as the second
sound is caused by the closure of the valves of the aorta
and pulmonary artery, if these do not close simul-
taneously, there will be a repetition of the second
sound.

The sign has no clinical or pathological interest,
being of a temporary nature, and generally removable by
a little exercise, changing position, or by full inspiration.

ORGANIC MURMURS.

By this term is meant those murmurs which are sub-
stituted for the normal sounds of the heart or accompany
these sounds, and are caused by organic changes in the
valvular orifices. These organic changes are generally
produced by inflammatory diseases of the endocardium,
and especially by acute rheumatic endocarditis.

Endocardial murmurs have a blowing, rushing, hiss-
ing, or cooing character.

If a vulcanized india-rubber tube be attached to a

ORGANIC MURMURS.

water-tap, and a current of water passed through, and
then a constriction be made by pressure on some point
of the tube, murmurs result more or less loud in propor-
tion to the force of the current of water and the amount
of constriction employed, and such affords a very fair
illustration of the rationale of all murmurs produced by
roughening or constriction of the valvular passages, as
from inflammatory deposits, rigidity of valvular orifices,
excrescences or puckering of the valves rendering them
incompetent.

Further, hypertrophy of a ventricle without a corres-
ponding enlargement of the valvular outlet, converts
that outlet virtually into a constriction, and a murmur
will result.

Organic disease may exist in a valve, and yet no
murmur be discoverable if the action of the heart be
quiet. Hence sometimes the standing position, by
increasing the action of the heart, will call out murmurs
unheard in the recumbent position ; while, on the other
hand, the recumbent position, by sometimes labouring
the heart, or perhaps by throwing the current of blood
somewhat obliquely instead of directly through an
orifice, will evoke murmurs unheard while the patient
is standing or sitting at his ease. Hence slight mur-
murs may escape detection, unless examination be made
while the patient is in different positions.

The loudness of a murmur is usually in proportion to
the force of the blood- current, and the extent and
roughness of the obstructive disease, and the denseness
of the tissues, and the smallness of the aperture through
which the blood is forced ; but such loudness is no
trustworthy measure of the seriousness of such disease.

TIIE HEART.

For instance, a hard constrictive obstacle at the aortic
orifice will produce a much louder murmur than
mitral incompetency, and yet the latter is a far more
serious disease than the former ; and so also, a strong
current of blood passing over rough surfaces will pro-
duce a loud murmur, while a flabby heart slowly pro-
pelling blood over soft diseased orifices may produce
no murmur whatever, and yet the patient may be in the
first instance in a good and safe state of health, but in
the second instance in hourly fear and danger of death.
Further, if there be a spamemic condition of the blood,
an organic lesion of inconsiderable importance may
produce a loud murmur. Atrophy of the valves, or of
the chordae tendinse have been described as occasionally
occurring without previous inflammatory disease, and
such a condition of things may be the cause of organic
murmurs.

INORGANIC MURMURS.

Inorganic murmurs are loud in proportion to the
thinness of the blood and the force of the heart’s action,
and are such as are heard in chlorotic females. Such
murmurs are also heard after fevers, or in the impover-
ished and low-fed, or in cachectic diseases, as cancer,
or after loss of blood from disease or the lancet.

Such murmurs are produced almost exclusively at the
valves of the aortic and pulmonary arteries. Murmurs
of this kind usually coexist in the same person with
venous hum, which is a corroborative testimony in
favour of their inorganic origin.

Inorganic murmurs may also occur with normal blood
in the hysterical, or under strong excitement, or in

INORGANIC MURMURS.

spasmodic action of the heart, forcing an impetuous
current through the aortic orifice.

It may be occasionally difficult to distinguish an
organic from an inorganic murmur ; but the general
aspect of the case, its history, the presence or absence
of venous hum, the presence or absence of the rheu-
matic diathesis, and the persistence or otherwise of the
murmur under changed bodily circumstances, should be
sufficient evidence in almost every case on which to
form a conclusion. However, it must not be taken for
granted that, because a murmur disappears under treat-
ment, that therefore that murmur was functional ; for, as
we have seen, organic murmurs may disappear, or at
least become of questionable existence when the action
of the heart is quiet.

Further, a murmur found in a chlorotic female is, in
the great majority of cases, of blood origin, but still
such a murmur might be structural, and indeed it may
sometimes demand a knowledge more subtle than can
be conveyed by mere rules to distinguish the one from
the other in obscure cases.

Organic murmurs, as we have already observed, arise
from an abnormal condition of the valvular orifices, and
are distinguished as obstructive murmurs and regurgi-
tant murmurs ; or, in other words, murmurs arising from
obstructions to the free current of the blood, or mur-
murs from incompetency of the valves, permitting
regurgitation of the blood. Such murmurs occur at
the aortic, pulmonary artery, mitral and tricuspid
orifices.

Mitral regurgitant murmur occurs when the left
ventricle contracts, and the mitral valve from insuffi-
ciency permits a portion of the blood to be driven back

THE HEART.

into the left auricle. This insufficiency of the valve
may have been the result of acute or chronic endocar-
ditis, rupture of one of the chordae tendinse attached to
the valve., a patulous condition of the valve from an
enlargement of the orifice, or contraction of the colum-
nar carnese, or growths on the valves. This murmur
is heard best at a little above the left apex. (See
diagram.)

Mitral obstructive murmur is to be heard at the
same locality as regurgitant murmur ; but with obstruc-
tive disease at this valve there may not be heard any
murmur, the passage of the blood from the auricles
into the ventricles being of a passive character as com-
pared to the rush with which it is driven out of the
ventricles into the arteries.

Tricuspid regurgitant murmur is heard best at or near
the ensiform cartilage (see diagram), but regurgitation
may here exist, and yet escape observation, not only be-
cause it may be covered, by the far louder mitral regur-
gitant murmur, but because in itself it is but a feeble mur-
mur as compared with mitral murmur. As in tricuspid
regurgitation, the blood is drawn back into the right
auricle, the jugular veins become distended and pul-
sate, but more promptly so in the left than in the right
jugular; and tricuspid and regurgitant murmur may
occur without perceptible jugular pulsation — probably
from the vena cava and innominate yielding so much
as to render jugular dilatation unnecessary.

Tricuspid obstructive murmur ; that is, a murmur
produced by an impediment to the passage of the blood
from the right auricle to the right ventricle, is rarely met
with. Aortic obstructive murmur is heard best about
mid-sternum, opposite the third interspace (see dia-

PERICARDIAL FRICTION SOUNDS.

gram) . It is the loudest, shortest, and most common
of all cardiac murmurs. It may be necessary to
remember, that murmur from the passage of the blood
through the foramen ovale, as in cyanosis; andaneurismal
murmurs, are best heard also at mid-sternum.

Aortic regurgitant murmur is also heard best at mid-
sternum, and is caused by the elastic contraction of
the aorta forcing back a portion of its contents through
the aortic valve, which may be patulous from puckering,
rupture, or inflammatory deposit.

Pulmonary artery obstructive murmur is heard best
at the sternal end of the third cartilage ; it is a mur-
mur of rare occurrence, and still more rare is regur-
gitant murmur at this orifice.

Aortic, mitral, and tricuspid murmurs are the most
frequent ; and especially aortic and mitral ; as might
be anticipated, murmurs belonging to the powerful,
viz., the left, arterial side of the heart.

Tricuspid regurgitant disease tends to produce con-
gestion on the brain and liver, while mitral regurgitant
disease tends to produce congestions on the lungs ;
both mitral and aortic regurgitation tend to produce
syncope. These are the three most serious valvular
diseases ; and of the three it may, perhaps, be said that
tricuspid regurgitation is the most serious ; mitral the
next, and that of the aorta the least so. But of this,
more afterwards.

PERICARDIAL FRICTION SOUNDS.

These friction sounds are produced during the
action of the heart, when, instead of the normal lubri-
cating surfaces, there is some roughness present, which.

THE HEART.

in almost every case, is the result of inflammatory
action, producing a deposit of lymph. The sound pro-
duced may he grazing, rubbing, creaking, squeaking or
whistling, or clicking, in character, according to the
softness, roughness, dryness, or stickiness of the deposit.

Such sounds are best heard usually with the systole,
and during strong action of the heart.

These friction sounds may appear and disappear
within six hours — the sudden disappearance of a mere
grazing friction may be from the mere subsidence of an
inflammatory injected state of the surfaces, or the disap-
pearance of a certain dryness of the surfaces — but where
loud friction suddenly disappears, it must be owing, in
most cases, to the occurrence of sufficient pericardial effu-
sion to separate the two surfaces, and thus prevent
friction ; six ounces of fluid is said to be sufficient to
effect this.

In rare cases, it may be difficult to distinguish pleu-
ritic friction in the cardial region, from pericardial
friction produced on a pleural surface; but pleuritic
friction confined to this region is rare ; and the one is
produced by respiratory movement only; while the
other, viz., the friction of a healthy pericardium on a
rough pleura, will be produced both by the movements
of the heart and the respiration.

It may also be sometimes difficult to distinguish peri-
cardial friction from endocardial murmur, but the
former is more superficial, and is increased by the
patient bending forward, and thus bringing the peri-
cardium nearer to the chest wall ; also by pressure with
the stethoscope occasionally, and its having a more
rubbing character.

PHYSICAL SIGNS OF THE ARTERIES AND VEINS.

The arteries may he perceived to pulsate with
abnormal distinctness in aortic regurgitation, not only
because there is usually in such cases hypertrophy of
the left ventricle, but, as it appears to me, because the
regurgitation permits a more complete rebound to be
made by the artery, in the thin and aged, where the
vessels are, as is often the case, turgid, the arterial pul-
sations are also abnormally distinct.

The pulse is an index to the condition of the heart in
structural disease. It is hard and full in hypertrophy;
feeble, and soft, and intermittent in fatty degeneration ;
small and hard in aortic constrictive disease, full but
abruptly short in hypertrophy with aortic regurgitation,
and it may be full, but soft, and melting, and inter-
mittent in mitral regurgitation. An intermitting pulse
occurs in feeble, fatty, or nervous heart, and in mitral
regurgitant disease.

Percussion furnishes no sign as to the position of the
aorta when normal ; and aneurisms, being generally
globular and touching the chest walls only at a tangent,
may present but a very small surface for percussion,
and yield but a very small space of dullness ; and, there-
fore, their diagnosis will be readier made out by the
pulsation or thrill they may furnish, and there may
be considerable dilatation of the aorta or its arch, fur-
nishing no signs on percussion.

The sounds of the heart are carried by conduction
along the arteries to some distance, but when arterial
sounds are heard as far from the heart as the popliteal
artery, the sounds are probably merely local friction
sounds, and are heard with distinctness in proportion

TIIE HEART.

to the force of the heart’s action, a thin condition of the
blood increasing the intensity of the sounds. Aneu-
rism al dilatations, by breaking the even flow of the
blood, or arterial contractions, or puckering, or rough-
ness, produce arterial murmurs, which may be heard over
the lesion, or may be transmitted along the arteries.

A murmur at any point in the aortic arch, harsher
than that found at the region of the aortic valves, may be
inferred to be a sign of some morbid condition in the
arch, or of pressure on the arch.

If there be a spansemie murmur in an artery, pressure
of the stethoscope, or by a tumour, or by any other
means, will convert the blowing inorganic murmur into
a sharp “ whipping” murmur.

Venous system. — Congested or enlarged veins gene-
rally indicate an obstruction somewhere to the circu-
lation.

Congestion of the jugular veins may indicate obstruc-
tive pressure on the descending vena cavse, as from a
tumour, or aneurism, or tricuspid regurgitation ; but in
this last case there is usually pulsation in the jugulars.

Emphysema, some forms of spasmodic asthma,
bronchitis, or congestion of the lungs, by impeding the
flow of blood, also tend to produce a swelled condition
of the jugulars and other veins of the neck.

Eull inspiration, by increasing the lung space, tends
to withdraw the blood from the jugulars ; and, therefore,
in cases of difficult diagnoses as to tricuspid regurgi-
tation, it may be necessary to suspend the breathing for a
few seconds, otherwise the jugular pulsations may not
appear.

Venous murmurs, humming, blowing, or buzzing, are

DISEASES.

intensified by rapid respiration, increasing the rapidity
of the flow of blood. They are much more frequently
met with in the female than in the male, the female
being more liable to anaemic diseases. These murmurs
are heard best over the jugulars and the superior longi-
tudinal sinus, viz., over the vertex, but “ especially at the
trocular Herophili, where opposing currents meet,’” viz.,
at the occipital protuberance. Pressure by the stetho-
scope over the jugulars is apt to create murmur ; but
this source of fallacy from pressure cannot take place
over the longitudinal sinus.

This venous hum is often to be heard in children and
in others in perfect health ; but is usually in the adult
a sign of poverty or deficiency of blood, and is distin-
guished from arterial murmur by being continuous, and
not rhythmic, as arterial murmurs are.

The sign is one more of curiosity than of clinical
interest, the visible signs of anaemia being much more
certain.

Should a lateral communication exist between an
artery and a vein, there is a whizzing murmur syn-
chronous with the systolic action of the heart.

DISEASES OF THE HEART.

Diseases of the heart are functional and organic.
Palpitations or over-action, irregularity of action
causing fluttering, excessive slowness of action, exces-
sively weak action, temporary stoppage, causing
syncope or swooning, may be caused by dilatation,
atrophy, fatty degeneration, flabby heart, valvular
disease, or by the quantity or quality of the blood ;

THE HEART.

but they may likewise all arise from hysteria, nervous
excitement, depression, dyspepsia, and especially flatu-
lence, bodily excitement or exhaustion, or mental
excitement or depression.

If excentric hypertrophy or valvular disease exists,
such are usually readily recognised ; but the existence
of concentric hypertrophy and fatty degeneration are
not so easily proved, while even excentric hypertrophy
may be concealed by an emphysematous expansion of
the lungs. Further, as we have seen, organic murmurs
may be only pronounced during strong action of the
heart, while a congested state of the heart may simu-
late hypertrophy.

A puffiness about the eye-lids or the ankles may give
rise to a suspicion of organic heart disease, but such
symptoms may arise from mere debility, from a
spansemic condition of the blood, or after the patient
has taken arsenical medicines.

The absence of pain is no proof of the non-existence
of organic disease, while the presence of excruciating
agony, as in angina pectoris, may furnish, on post-
mortem examination, no mechanical explanation what-
ever.

A certain undefinable aspect and expression, con-
nected with prominence, anxiety, restlessness and
glistening of the eye — an aspect often present in the
gouty or rheumatic — is not unusual with those who have
organic disease of the heart.

The general condition of the body, and, I think,
especially the texture and quality of the hand, will be
occasionally found to be to some extent an index to the
textural condition of the heart.

PALPITATIONS.

Palpitations, and especially hysterical palpitations,
which are sometimes more intense than any other form,
may be so strong as to shake the patient and the
bed he lies on, and may produce sounds which are heard,
not only by the patient himself, but by those near him,
especially those who may be in or on the same bed; and, if
the ear or stethoscope be applied to the chest, the
sound heard may be loud and ringing. Nervous palpi-
tation lasting some time, and accompanied by anaemic
murmurs, might deceive the physician into the belief
that organic disease was present.

Palpitations may be caused by hypertrophy of the
heart, or one form of palpitation, where considerable
palpitation is immediately followed by an almost
imperceptible pulsation, may be caused by fatty or
flabby heart; however, palpitation is usually an affec-
tion depending on the condition of the brain or spinal
and pneumogastric nerves, and may arise from an
excitable condition of the heart ; nervous debility ;
hysteria ; the result of the excessive use of tea, coffee,
or alcohol ; or from late hours ; novel, or other
exciting reading; constipation, flatulence, indigestion,
torpid liver ; or a gouty condition ; over-bodily exercise,
especially in growing young men ; and with such,
especially, probably a frequent cause is masturbation.

With nervous palpitations there is often hurried or
difficult breathing — in the female, especially, a ten-
dency to syncope ; in both sexes, flushing, giddiness,
headache, the fear of death, and a desire to press upon
and control the heart, as it were, with the hands.

TIIE HEART.

TREATMENT.

The treatment of organic palpitations will be consi-
dered with the treatment of those diseases producing it.
The allopathic treatment of nervous palpitation consists
chiefly in the use of Assafcetida, Musk, Valerian, Ilyos-
cyamus, Hydrocyanic acid. Camphor, the shower-bath, &c.

The homoeopathic remedies chiefly administered in
functional palpitation of the heart are Aconite, Aurum,
Digitalis ferrum, Musk, Lachesis, Cobra, Pulsatilla, Nux
V omica, Coffea, Ignatia, Lobelia.

The homoeopathic treatment of nervous palpitations
has this advantage over the allopathic treatment — That
we never, as from a false diagnosis, prescribe depleting
remedies ; nor can we ever interfere injuriously with the
digestive organs ; that palpitations arising from consti-
pation does not necessitate the administration of
exciting or weakening purgatives; that in the use of
Nux Vomica and Pulsatilla we possess two remedies, the
first acting on the digestive and spinal system of the
male, and the second on the digestive and uterine
system of the female — which I believe to be more
successful than any remedies possessed by our oppo-
nents. In the employment, also, of Lachesis and Cobra,
especially in that form of nervous palpitations accom-
panied by flatulence, we possess two other remedies
totally ignored by allopatliists, and yet in our hands
generally producing most satisfactory results.

The specific use of Coffea and Camphor are also
very useful remedies ; while, the employment of
camphorated spirit — one, two, or three drops on a
piece of sugar — is often successful as a temporary

PALPITATIONS.

palliative. In cases sufficiently severe to call for
immediate relief, a strong cup of tea or coffee
is usually immediately successful; but it is a remedy
which should be had recourse to as seldom as possible,
as a large proportion of cases of palpitation in the
female especially arise from the abuse of tea. Strong
tea, and especially green tea, are totally inadmissible in
cases of habitual palpitation, and it must often become
a question whether tea and coffee must not be entirely
discontinued. Occasionally fits of most intense palpi-
tation have resulted from the excessive use, especially,
of green tea, in which case wine or brandy-and-water
may, as an extemporaneous remedy, be necessary.

The following also are to be considered — Palpitations
from debility, Yeratrum album ; in plethora, Aconitum ;
from loss of fluids, China ; Colchicum in gouty cases ;
and Cocculus often in dyspeptic cases.

The hygienic treatment will consist in taking gentle
exercise in the open air in proportion to the strength ;
moderation in diet, the very sparing use of stimulants,
the quiet performance of daily duties, and the keeping of
early hours, the employment of the cold or tepid sitz-bath,
according to the reactive power of the patient, every morn-
ing, for about five to eight minutes. In exacerbations, the
tepid sitz-bath, or tepid fomentations over the spine or
over the region of the heart, are generally soothing; but in
exacerbations a readier, and frequently a very gratify-
ing result, will immediately follow the gentle, yet firm
application of the right hand of the physician or a
friend over the region of the heart, while the corres-
ponding spinal region is pressed with the left hand.

In those subject to nervous palpitations, much good will
often result from the exercise of that moral control

THE HEART.

over tlie selfish gratification of the mental and bodily
affections and passions ; the cultivation of which power
of control every human being should consider as his
high privilege. And when we reflect that the habit, so
to speak; of palpitations; is like other habits; often to be
eradicated by self-watchfulness ; while; on the other
hand; like other bad habits; it grows on what it feeds
oil; and in time produces actual organic disease, there
exists a very powerful motive to self-control. This self-
control is not to be confined to the control over what
are called the evil passions, but control over all inor-
dinate desires; for instance, the midnight student of
divinity, preparing either for honours or for the pulpit,
and unnaturally, night after night, stimulating his
mental energies at the expense of his after-life, by strong
tea or green tea, is alike a trespasser against God's law,
although in a less gross manner, with the sot, who stimu-
lates his lower passions with alcohol.

SYNCOPE.

Syncope, fainting, or swooning, is an event much
more frequent with the female than the male, and is
much more frequently the result of nervous derange-
ment than of organic disease.

A habit of fainting is a common occurrence with the
hysterical, and instances appear where, without the
presence of hysteria, swooning fits occur in individuals
from the age of puberty to seventy years of age.

Weakness of the heart, flabby heart, fatty heart, and
valvular disease, acute softening of the heart in typhus
fever, pericardial effusion, nervous hysteria, violent
emotions, fright, pregnancy, amenorrlioea, disappoint-

SYNCOPE.

merits, especially in love, sudden fits of joy or grief,
ancemia, loss of fluids by diarrhoea, or flooding or
other haemorrhages, and tapping, are all frequently fol-
lowed by syncope.

In cases of feeble heart, syncope may occur, if the
individual from the sitting rise suddenly to the erect
position ; and, in cases of chronic diarrhoea, flooding and
other debilitating disease, death has often resulted from
this accident.

Syncope is usually preceded by anxious sensations
and stricture about the chest, and is accompanied by
a death-like pallor.

The cause of syncope is deficient action of the heart,
by which there is the absence of a sufficient circula-
tion of arterial blood in the blood-vessels of the brain ;
and is, therefore, the reverse of that form of coma which
often closely simulates syncope, that is caused by pres-
sure on the brain, but it closely resembles that form
of coma which results from the prostration of brain
power.

In some forms of hysterical syncope the face is rosy,
and the pulse even full. It may be questioned whether
this is true syncope, in which the face has a death-
like paleness, and the pulse is either exceeding faint
or quite imperceptible; the action of the heart, as
learned by auscultation, being excessively feeble and
slow, and even for a brief space apparently stopped.

The respiration also may be so feeble as to be imper-
ceptible, and only to be demonstrated by the vapour
condensed on a mirror held to the mouth.

Recovery is accompanied by yawning, gasping, slow,
heavy breathing; it may be by hysterical crying or
vomiting.

THE HEART.

Coma is to be distinguished from syncope by the pre-
sence of a pulse, natural, or full and laborious.

Trance, either spontaneous or mesmerically pro-
duced— (and in passing, I may observe how strange it
is that all medical men believe in somnabulic trance,
and yet stubbornly refuse to credit what is called mes-
meric trance) — may simulate syncope exactly, and often
has simulated fatal syncope, and the most horrible
results have ensued, the victims having been buried
alive. According to Dr. Willan, as quoted by Dr.
Elliotson, lethargy or trance is occasionally met with
among the Jews, lasting days and even weeks. In
trance, the body is not absolutely cold, and the thermo-
meter placed in the mouth or in the anus will indicate
the presence of life-heat. Hot wax dropped on a dead
body will cause no blister, but a blister will arise
under this treatment in trance. As, however, decom-
position is the only infallible sign of death, accidents so
dreadful as those referred to are not now likely to occur
in any civilised country.

Dr. Elliotson, in writing on trance, in his f Practice
of Physic/ gives the history of two sisters who died
in trance fits ; and recently, the case of a young lady
came under my notice, in whom death was the result
after three months of trance ; the patient taking small
quantities of food, and occasionally shedding tears during
the period.

The Treatment of syncope must be much the same
under all svstems of medicine. In moderate cases, the

patient, if placed in the horizontal position and left
alone, will soon recover ; in more acute cases, the
patient should be laid with the head low, the cravat,
shirt, stays, or dress, should be loosened, cold water

SYNCOPE.

sprinkled in the face, and the windows thrown open,
to get all the air possible ; the curious should avoid
crowding round, and no violence should be used. The
Marshall Hall method for the restoration of the
partially drowned may be employed in extreme cases ;
viz., dashing the body with cold water, and working on
the body, so as alternately to compress and dilate the
chest, and slowly rolling the patient from his side to his
face ; the prone position being more favorable than the
supine for the efforts of respiration.

Smelling salts or brandy are not so efficacious
as the above treatment ; but frictions over the
heart, with or without the external and internal use
of brandy, would be useful.

I do not find that means are persevering! y attempted
to restore those in whom syncope for organic heart
disease passes on to death ; but if apparently still-born
children, or the apparently drowned, have been reco-
vered after efforts perseveringly employed for one or two
hours, why should the same not be attempted in the
above instances ? Bleeding from the arm or the jugular
vein, in such cases, seems to be almost the only means
attempted by medical men.

In the cases of swooning after excessive eating,
instanced by Dr. Herring in one of the numbers of the
‘ British Journal of Homoeopathy/ tickling the fauces
with a feather or the finger, by producing vomiting, at
once restored the patients to consciousness — bloodletting
having in one of the instances been previously perpe-
trated by an heroic practitioner !

In threatened syncope from weakness, or in actual
syncope from weakness or loss of fluids, wine or brandy
and water must of course be used ; China being after-
wards useful in such cases.

THE HEART.

If there be a tendency to syncope from uterine or
intestinal irritation, or mental emotions, the employ-
ment of Pulsatilla, Sabina, Nux Vomica, Ignatia, the
sitz-bath, &c., would be found very serviceable ; while
if the tendency be from weakness of the heart, Digitalis,
Aurum, Lachesis, or Cobra, will often relieve pressing
symptoms. But the mild bracing treatment of free
air and the tonic action of the cold water appliances,
are more to be depended on for a cure ; but of syncope
from weakness of the heart, we shall speak further when
treating of the organic diseases of that organ. Much
may be expected from hygienic treatment in a tendency
to nervous or dyspeptic syncope ; viz., from gentle exer-
cise on foot, horseback, or in an open carriage ; suitable
clothing ; abundance of fresh air, avoiding coddling, or
an over-indulgence in tea, coffee or wine, crowded or
over-heated rooms, late hours. The absence of gas,
or its thorough ventilation in sitting rooms is an im-
portant consideration. Finally, that moral discipline
which is so essentially necessary in the treatment of
hysteria, must not be forgotten.

ANGINA PECTORIS.

The symptoms of this terrible disease, which I
have often painfully witnessed in the person of a
much-esteemed friend, and who ultimately died in
a paroxysm, may be taken as a generic history
of such cases. T. G — , a retired East Indian surgeon,
was of the gouty diathesis, but, up to the age of sixty-
five, although latterly of an indolent habit of body,
enjoyed robust mental and bodily health. Ilis wife,
who had for years suffered acutely from spinal irritation,
died suddenly. On this intelligence being given to Mr.

SYNCOPE.

G — , he was at once seized with intense agony in the
heart ; and, for the three remaining years of his life, at
intervals varying from twenty-four hours to several days,
he was seized with agonising pains in liis heart, generally
beginning by numbness in the jaw and left arm. During
the fits he would stand pressing liis hands against the
precordial region, or stand pressing liis heart against
the mantel-piece or a field-gate, or any other object
which came conveniently to hand. During the paroxysms,
the expression became stern, but fortunately the agony
lasted only one or -two minutes ; and when gone, he
became again at once cheerful, although he always told
me that he felt convinced he would one day expire
during a paroxysm. The fits usually came on after any
mental or bodily excitement, even of the most trivial
kind. During a paroxysm the pulse beat regularly and
moderately, and no murmur or any abnormal sign could
be detected in listening to the heart. His death verified
his own prediction, and he was found one morning by
his man servant half out of bed, and heaving his last gasp.

The nature of this disease is not less obscure than
that of neuralgia generally. The fact of the pneu-
mogastric nerve being implicated, will explain some
of the secondary symptoms. The doctrine of spasm
explains nothing, and in the case of my friend there was
no evidence of spasm. Dr. Stokes says that weakness
of the heart is a common accompaniment, and Dr.
Walshe says he has never met with true angina in
the possessor of a strong hypertrophous heart. Old
writers assign ossification of the coronary arteries as
one great cause, but add that post-mortem examination
often furnishes no explanation of the cause of the agony
or of death. Dr. Stokes believes that some form of

THE HEART.

organic alteration exists in all cases ; and Dr. Walsh e be-
lieves that in some six or seven cases which have come
under his inspection, flabby dilatation existed in all.
But this fact furnishes no explanation of the cause of
the agony ; and a flabby condition of the heart is not
unlikely to be the result of that impaired nourishment
which long-continued suffering in the organ might be
expected to produce ; this at least will be allowed, that
angina pectoris does not accompany flabby heart in the
majority of cases.

Of eighty-eight cases collected by Sir John Forbes,
eighty occurred in males, and seventy-two had passed
their fiftieth year ; age being thus shown to be, in the
great majority of cases, an element in the disease, might
indicate the probable existence of structural change as
an element in the disease. But the sudden appearance
of the disease, and the fact of its being rare among the
poorer classes, is adverse to this theory. Flabby
heart, however, is not so likely to occur with the
working man as with the indolent.

Death, when it occurs in this disease, is usually from
syncope.

TREATMENT.

Allopathic treatment has consisted in bleeding,
cupping, blistering, issues, setons, galvanism, tonics,
arsenic, nitrate of silver, sulphate of zinc, belladonna
plasters, and much stress has been laid by Dr. Elliotson
on prussic acid, and by Latham, on opium, in doses of
sixty drops of laudanum ; chloroform has been recorded,
internally, and externally applied.

Homoeopathic treatment , so far as I know, although
it has avoided the worse than useless barbarity of much

ACUTE PERICARDITIS.

of the Allopathic treatment — and must always seek to
discourage the use of remedies like hydrocyanic acid
and opium, at the discretion of patients, in whom the
intense agony must sometimes tempt to suicide — cannot
yet claim many triumphs in the treatment of acute
angina pectoris. But Nux Vomica, Spigelia, Aurum,
Lachesis, Bryonia, Rhus tox., and Belladonna, are some
of the remedies to be kept chiefly in view.

Mesmerism , also, is most worthy of a trial ; and if the
paroxysm can be traced to have any connexion with the
state of the digestive organs, we may congratulate our-
selves that our remedies will be of much service.

Neuralgic pains in the stomach, especially as such
often extend to the shoulder and arm, or gouty pains
in the heart, or pains of a rheumatic origin in the heart
or in the precordial muscles, may simulate angina
pectoris of a mild type. Such pains are apt to show
themselves in chlorotic girls, and also in “ fast young-
men ” and boat racers. This spurious angina is much
more under our control by the employment of remedies
for the male, such as Nux Vomica, Bryonia, Rhus, and
Arnica ; or Ferrum and Pulsatilla, for the female.

It is scarcely necessary to add that both for true and
spurious angina, a mild diet, and a regular and moderate
mode of living are essentially necessary.

ACUTE PERICARDITIS.

The most acute instances of this disease are met
with in men from the age of twenty-five to forty.
Inflammation in the pericardium produces on the
surfaces of that membrane, redness, congestion, and

THE HEART.

vascular roughness, heyoncl which the disease may not
proceed, in which case it is styled dry pericarditis ; hut,
under Allopathic treatment generally, and often under
Homoeopathic treatment, this stage is succeeded by a
plastic exudation, and this is followed by serous or other
effusion more or less. As the disease declines, the
serous effusion becomes absorbed, the plastic exudation
disappears slowly, but the pericardium may become per-
manently attached to the heart by strong fibrous adhe-
sions, in bands or over the entire surface.

The plastic exudation, as exhibited in the post-mortem
examination, is yellow or reddish-yellow in colour ; it
sometimes resembles in colour, consistence, and papil-
lary form, two buttered surfaces which have been sepa-
rated. Sometimes it covers the heart with a deposit re-
sembling lace- work, and may be found from the thinness
of tissue paper to the thickness of orange peel, and from
the softness of butter to the hardness of cartilage.

The effusion, generally purely serous, may be sero-
sanguineous, sero-purulent or sero-fibrinous, and the
quantity is from one or two ounces to half a pint,
although in extreme cases, three or more pints have
been found.

Serous effusion is readily reabsorbed ; but a sangui-
neous or purulent effusion disappears with much more
difficulty ; while in that residuum which may chronically
remain from plastic exudation, calcareous and fibrous
pseudo tissues may become formed as permanent de-
posits, although generally all traces of exudation dis-
appear, so far as physical signs are concerned.

Pericarditis may appear after wounds in the chest,
or owing to pus in the blood, after any extensive
sloughing has taken place ; as after an untoward ampu-

ACUTE PERICARDITIS.

tation, especially in those given to dram drinking.
Typhus fever, tubercle, cancer, delirium tremens, pneu-
monia, or pleurisy, are also occasionally accompanied
by pericarditis ; but the great majority of instances in
which we meet with it, is during attacks of acute rheu-
matic fever.

Physical Signs. — At the first onset of pericarditis,
there is only an excited action of the heart ; and Dr.
AValshe advises that, at this stage, the point of the apex
beat of the heart be marked, in order that the
amount of any subsequent displacement by effusion may
be noted.

TVhen exudation has taken place, there is friction
sound ; and if murmur also be heard, this may be from
a simultaneous attack of endocarditis, although the
murmur may be from former affection of the valves.

If effusion be only to the extent of a few ounces, there
may be no extension of precordial dullness discoverable
by percussion ; but if the effusion be extensive, there
is not only an increased surface of dullness, but also
precordial bulging, and a certain undulatory motion
with each systole of the heart. Before copious effusion,
there will be found friction vibration ; but after copious
effusion, on application of the hand, the impulse of the
heart may be imperceptible or fluttering. An emphy-
sematous condition may exist over the region, in which
case no vibratory action may be perceptible even before
effusion. If the pericardium be not filled with effusion,
the region of dullness on percussion will somewhat vary
with the erect, recumbent, or lateral position of the
patient. In cases of copious effusion, the cardial sounds
may be entirely obscured, except over the base of the

THE HEART.

heart, and the friction sounds become inaudible ; or,
indeed, friction may be prevented under such circum-
stances. As absorption advances, the beat and friction
sounds will again gradually reappear.

If adhesion take place between the heart and the
pericardium, friction sounds must of course be absent,
unless we admit the possibility of friction between the
external surface of the pericardium and the walls of the
chest or pleura ; and if no observations have been made
until this condition of things has taken place, there
may be some uncertainty in the diagnosis.

A certain amount of difficulty may sometimes exist in
distinguishing friction from valvular murmurs ; but fric-
tion sounds are frequently heard with both the upward
and downward motion of the heart — and they are gene-
rally heard with increased intensity on pressing firmly
with the stethoscope. Friction sounds may disappear,
from the disappearance of all roughness, the absorption of
the exudation, or from effusion coming on, or from ag-
glutination of the pericardial surfaces ; but, if friction
sound should suddenly disappear while the disease is still
active, and when there is no increased dullness on per-
cussion, indicating copious effusion, the presumption
is, that the then inflamed serous surfaces having become
adherent, friction has ceased, owing to the agglutination
of the pericardial surfaces.

Symptoms. — The chief symptom is pain in the region
of the heart, but this pain, as in pleurisy, may vary
from a mere sense of uneasiness to acute agony— a fact
not readily to be explained — although we know that in
some individuals, pain, caused by disease, seldom ex-
ceeds mere discomfort, while in others even slight

ACUTE PERICARDITIS.

ailments are often accompanied by almost unendurable
agony.

This pain, iu the region of the heart, may shoot up
to the shoulder, or down the brachial nerves.

The patient usually has an anxious expression, and
generally prefers lying on his back. The ankles are
often cedematous, but this is most frequently caused by
the presence of the rheumatic affection in the feet. If
the effusion be great, there may be lividity of the face
and neck. There is usually a dry, short, irritating
cough. The pulse is that of fever, but if the
heart be hampered by effusion, the pulse will be
irregular.

Hysterical, delirious, tetanic, and even maniacal
symptoms may show themselves in certain constitutions,
or in extreme cases. Temporary hemiplegia may also
appear, and also a tendency to syncope — from the ex-
haustion of the heart, laboured as it is by excitement,
by effusion, or, it may be, by adhesions ; and if death be
the final result, it is usually' by syncope.

Risus Sardonicus and clammy perspirations are
generally fatal symptoms. Pericarditis may rapidly
destroy life ; while in cases which recover, the duration
of the acute symptoms is from two to three weeks — the
friction sounds remaining often for months.

Pericarditis, more than any other acute inflammation,
is apt to recur ; a fact sufficiently explained by the
other fact of its being chiefly the result of acute rheu-
matism, Hz., exacerbations of a constitutional con-
dition.

The Diagnosis is, in the great majority of cases,
quite simple, and is formed from the presence of
fever, pain at the heart, extension of dullness on per-

TIIE HEART,

cussion, and friction sounds. If rheumatic fever he
present, the diagnosis will be more certain. But, in
exceptional cases, there may be so little fever that the
attention of neither the patient nor the physician is
directed to the heart. The friction sounds, if heard,
may be considered pleuritic ; and endocardial murmurs
may cover pericardial friction sounds, while the exudation
matter may be so soft that no friction sounds are
audible ; or the roughness may be on the posterior sur-
face of the heart, in which case no systolic friction
sounds might be produced ; further, if the pericardium
were partially agglutinated to the heart from former
disease, there might be no friction sounds, and no
effusion thrown out, sufficient for external measurement.

On the other hand, enlarged heart, with friction from
old exudation, accompanied by an attack of general
fever and pain at the heart, might mislead into the
diagnosis of pericarditis.

In illustration of this last source of fallacy, I find
recorded in my notes, the history of a case in Univer-
sity College Hospital, in 1850, where a most acute
and accurate physician spoke of the advisibility of
performing “ paracentesis to draw off the immense
accumulation of fluid,” but the post-mortem examination
showed only enlarged heart and a great accumulation of
deposited fat.

Laennec also confesses that he has sometimes suspected
pericarditis when it did not exist ; and has, on the other
hand, failed sometimes to detect it until the post-
mortem examination.

Pericarditis occasionally appears in a latent form, and
producing at first no prominent symptoms, may escape
notice unless revealed by the physical signs.

TREATMENT.

The Prognosis is unfavorable, if pericarditis supervene
on chronic Bright's disease ; but, even under what we
must consider as deleterious heroic treatment, uncom-
plicated pericarditis is not a very fatal disease.

Dr. Walshe says he has never known recovery take
place, if in the patient highly marked choreal symptoms
have occurred in childhood ; and that lie considers
the whole class of reflex phenomena, Viz., hysteria, mania,
or convulsions, as of very bad augury, when occurring
in pericarditis.

If the pericardium become agglutinated to the heart,
the action by that organ must become greatly laboured,
and more or less hypertrophy must, according to Dr.
Hope, ultimately be the result. Dr. Stokes, however,
and other writers believe, on the other hand, that agglu-
tination of the pericardium more frequently leads to
atrophy of the heart ; on the principle that the heart
becomes cramped in its action, and like other muscles
under such circumstances, ceases to be healthily deve-
loped. Acute pericarditis occasionally sows tlie seeds
of degeneracy in the texture of the heart. Endocarditis
also occasionally surpervencs on pericarditis, thus impli-
cating the valves.

TREATMENT.

Allopathic treatment consists in the usual antiphlo-
gistic routine. Dr. Hope recommends immediate and
copious bleeding from a large incision ; and, if necessary,
repeated two, three, or more times, followed by from
twenty to forty leeches to the precordia." Others
recommend “ moderate venesection." It is confessed
that “ raving madness" has followed copious bleed-
ing in this disease. “ Mercury is next in importance

TIIE HEART.

to bloodletting,” but Dr. Taylor’s evidence is against
mercury.

Colchicum, opium, blisters, purgatives, diaphoretics,
and diuretics, are also recommended.

The celebrated allopathist, Dr. Stokes, wisely says :
“ boldness of treatment in this disease often indicates
the timidity of the practitioner;” and, I may add, much
more frequently shows his ignorance.

In the 49th and 50th Nos. of the ‘ British Homoeo-
pathic Journal/ will be found two papers by Dr.
Bussell, on “ Some diseases of the heart.” With
reference to bloodletting, he quotes (No. 50, p. 555,)
the history of a case treated by the celebrated French
physician, Andral, and which I have abridged as fol-
lows : — “ A patient, set. 31, had suffered for a fortnight
from rheumatic pains in the joints, with redness and
fever, and at last was twice bled. Next day there was
no improvement, and he was bled again. On the
next day he was bled a fourth time. On the fourth
day, the joints remained swelled and painful ; twenty
leeches were therefore applied to the knee. On the
sixth day, there being no improvement, he was bled
a fifth time. He then seemed much better ; the red-
ness, pain, and swelling in the joints had subsided, and
at six in the evening the pain was entirely gone ; but
at ten o’clock he was suddenly seized with pain in
the left side. In the following morning, this poor man
was screaming with pain in the region of the heart,
but the pulse was soft and compressible ; the face pale,
pinched, and anxious ; the extremities were cold. It
was not thought prudent to bleed him again (!) but
thirty leeches were applied to the precordial region (! !)
and the patient died that evening.” It is impossible

TREATMENT.

to read this history "without horror, for the conviction
forces itself on the mind, that this poor man was — in
deference to most stupid and absurd theories — actually
bled to death ; and can we speak of such proceedings in
milder language, than that they are blood-thirsty and
atrocious.

Still, even the thoughtful and moderate Dr. Stoker
recommends the usual antiphlogistic treatment of bleed-
ing and salivation, &c., but not so far as in pleurisy.

Homoeopathic treatment is surely better than the
above. No “ raving madness” ever results from homoeo-
pathic treatment ; and those cases where tetanic spasms
show themselves and lead to such fatal results, are
chiefly in those who have been profusely bled; and
rarely, I believe, occur under homoeopathic treat-
ment. I further believe, that friction sounds — that
is, fibrinous exudation, is much more rarely met with
under homoeopathic than under heroic treatment.
Fatal syncope, under the old system, is often to be
dreaded in severe cases of pericarditis ; and yet it is just
in such cases that copious bloodletting is recommended,
than which nothing could be devised more likely to
bring about the fatal result.

During the first symptoms of pericarditis, the allo-
pathic practitioner, obeying Dr. Hope's instructions,
or the impulses of his own fear, has often put antiphlo-
gistic treatment into full force ; and has thus run the
double risk of treating as pericarditis that which was
not so, or of treating as a violent attack what might
have been only a mild form of the disease.

Homoeopathic treatment never causes death in
this disease ; but allopathic treatment, I am convinced,
has often been the cause of a fatal result.

TIIE HEART.

It is not to be pretended that this disease is so
markedly under the favorable influence of remedies as
some other forms of acute inflammation ; but by the
judicious use of the following remedies much alleviation
may be looked for.

Aconitum (Bismuth?) Bryonia, Ilhus tox., Colehi-
cum, Arnica, Spigelia — and, after effusion, Arsenicum.
In the acute stage, Aconite will be found the most
serviceable ; the frequency of the dose being in propor-
tion to the urgency of the case. The medicines chiefly
employed should be given in the second or third
decimal tinctures ; but, as acute rheumatism generally
lasts from three to six weeks, and pericarditis, more or
less intense, may exist from two to three weeks, much
patience is required both on the part of the sufferer and
the physician.

In exacerbations, hot fomentations over the precordia
will afford much relief. Mesmerism also will often
soothe the patient, and procure sleep in that restless
wakefulness which is often so distressing a symptom. I
will not assert that full doses of opium may not, in some
instances, where the pain is excessive, and when suf-
ficient relief cannot be otherwise obtained, and where
there is not copious effusion, afford an amount of relief
and rest which will be found almost necessary, yet, in
any heart disease with a tendency to syncope, there
is danger from the administration of opium, as the fol-
lowing case will illustrate :

Mr. S — , set. 60, but of a vigorous habit of body,
was often troubled with severe palpitations ; there being
present considerable enlargement of the heart, but
no murmurs. Lacliesis and other remedies were

TREATMENT.

usually given with satisfactory results ; but an unusually
severe exacerbation having supervened on great mental
excitement, in connexion with a certain love affair, I
found mesmerism on this occasion more successful than
any other remedy in allaying the excited and tumultuous
action of the heart. Mr. S — , being apprehensive of
a fatal result, called in a clergyman for spiritual conso-
lation. This gentleman, having no knowledge of
homoeopathy, immediately took upon himself, unknown
to me, to send in a surgical friend of his own, who
at once administered thirty drops of laudanum, with
the apparently satisfactory result of a good night’s
rest, followed by much composure of mind. I con-
fessed, next day, that the result appeared very satis-
factory; although, for myself, I confessed that I should
have been afraid, under the circumstances, to have
given so strong an opiate. The day following, all the
excitement of heart and mind returned, to be again set
at rest by thirty drops of laudanum. Sleep quickly
followed ; but this time it was “ that sleep which knows
not waking;” and a few hours after the dose had
been given, my friend was dead.

In the treatment of this disease, where there is any
tendency to syncope, the nurses and attendants must
be cautioned against either permitting or assisting
the patient to rise abruptly from the supine to the
sitting position, fatal results having sometimes followed
the neglect of this precaution.

In the treatment of acute pericarditis, with accom-
panying rheumatic fever, I believe that hot water fomen-
tations and other water appliances may be relied on with
great confidence ; and this, conjoined with the appro-
priate homoeopathic remedies, may well be considered

THE HEART.

a far more rational, and a much safer and a more ex-
peditious course to pursue, than the Colchicum, saliva-
tion, and bloodletting of allopathy.

The hot air bath, I also believe, would often be of
the greatest service in acute rhumatism of the heart ;
the drops of sweat thus extracted from the body, on eva-
poration, often leaving a residium of uric acid.

CHRONIC PERICARDITIS.

Chronic Pericarditis, so called, is that sequel which
succeeds the acute disease, especially in those of a low
power of constitution, or in spirit drinking, and I
believe more especially in those who have been “ half
bled to death.”

In such cases, besides adhesions, a certain amount of
softening, or more correctly, a certain softness and
weakness of the heart may have supervened, and be
accompanied by palpitation and shortness of breath ; or
purulent secretions may exist in the pericardium.

For the treatment of this sad state of things,
Allopathy recommends “Iodurated applications,” and
“ Mercurial inunction,” Digitalis and purgation, &c.;
and if these means fail, and there be much effusion,
“ paracentesis may be considered.”

But as what we are dealing with has been induced by
depravity of constitution, or perhaps by excessive medi-
cation, surely nothing could be more irrational and con-
trary to common sense, than to attempt to saturate the
poor victims with more iodine, mercury, or digitalis,
and to drag them down by purgation. What is required
is not depletion, but strengthening, such as may be got
by long-contiuued daily frictions over the precordium

ACUTE ENDOCARDITIS.

with oil, good simple food, and, perhaps, wine ; abun-
dance of gentle, warm and pure air : perhaps change of
climate may be necessary. In short, every hygienic
and invigorating treatment, and for Homoeopathic
remedies, Arsenicum, Aurum, Silesia, Calcarea, and
Sulphur, may be administered with a certain measure
of success ; and in such circumstances I should prefer
the 6° or 12° centessimal dilutions.

The Preventive treatment of pericarditis is worthy of
some consideration on the part of medical men, and
especially of those who consider preventive medicine
and general hygiene as the most important function of
the physician, and by those who do not look on patients
as conditions to be experimented with, but as human
beings to be preserved from evil and disease.

Typhus fever, to a limited extent, being one source
of pericarditis, we may reasonably and hopefully trust
that, in the progress of sanitary works, this source of
the disease will become still more limited. Excessive
spirit -drinking is another source, which the growing
temperance of the age is gradually diminishing. Of
rheumatic fever, which is the chief cause of pericarditis,
we cannot speak so confidently ; but this at least we
know, that pericarditis occurs chiefly in those who
have a strong constitutional tendency to rheumatism ;
and with such, a simple, temperate, unstimulating diet,
especially with reference to animal food, abundance of
fresh air, the free use of cold water, the very sparing
use of alcoholic stimulants, the avoidance of over mental
and bodily straining, and especially carefulness with
regard to damp houses, or sitting with wet feet or wet
clothes, should be closely attended to.

TIIE HEART.

ACUTE ENDOCARDITIS.

Acute Endocarditis is a disease which, like peri-
carditis, often accompanies rheumatic fever, and consists
in inflammation of the lining membrane of the heart,
followed by redness, vascularity, a general loss of
smoothness, or patches of effused lymph, or a general
greyness over the lining membrane, from infiltration of
exudation matter. This physical result may implicate the
chordae tendinse and valves, thereby impeding the free
action of these parts, or by a thickening of the edges
of the valves, or by puckering of such, render the
valves incompetent. The valves also may be softened
and enfeebled, or destroyed by inflammatory action.
Pus may be formed, and patches of exudation may
become detached, and both may circulate in the blood,
and being arrested by the lungs, liver, spleen, and
kidneys, set up suppurative disease. This is, however,
happily, a very exceptional result. Coagula also may form
in the cavities of the heart ; but this, I believe, will be
found to be almost entirely confined to such cases as
have been profusely bled.

The left, that is, the arterial division of the heart, is
much more frequently the seat of inflammation than the
right side.

Physical signs. — The heart being in a condition of
inflammatory excitement, beats rapidly and abruptly;
and the organ being more or less turgid with blood,
some increase of percussion dullness may sometimes be
made out; but this is a sign of not much diagnostic
importance.

When the valves have become suVect to soft deposit,

ACUTE ENDOCARDITIS.

or congested thickening, or the chordae tending have been
shortened by inflammatory deposit, there will be found
a soft, blowing murmur, almost entirely confined to
the aortic valve or the mitral valve, existing during
the systole, and therefore indicative of aortic obstruction
and mitral regurgitation. This soft murmur will
become loud and harsh if the deposit be hard, and the
action of the heart strong.

If the circulation through the heart be seriously
impeded, either by coagula or valvular disease, the action
of the heart will become embarrassed and irregular.

The Symptoms are those of inflammation — pain at
the heart, palpitation, dyspnoea, anxiety of expression,
headache, excitement, and perhaps a dry cough — but,
as in pericarditis : latent endocarditis sometimes occurs,
with scarcely appreciable symptoms.

If the circulation be much impeded, there may be a
tendency to syncope, which may be fatal, or coma may
result from congestion of the brain. In extreme cases,
the blood may be poisoned from the products of the
inflammation, and rigors, clammy sweats, and diarrhoea
be the result.

This disease is not often fatal, even under heroic
treatment, but a certain amount of implication
of the valves, proved by the presence of murmurs, is
under allopathic treatment a frequent result, and espe-
cially, I believe, if bloodletting has been extensively
practised, the almost invariable result — and such mur-
murs once established, almost always remain during
the life of the patient.

The valves may be subject either to deposit, rendering
their free edges irregular, or to puckering, and they occa-
sionally become agglutinated to the walls of the heart.

THE HEART.

If the mechanical alteration in the valves he slight,
there may be no further evil results, and the patient
may live and act with almost as much freedom as if no
endocarditis had ever existed. If the implication of
the valves be more serious, there will be occasional pal-
pitations, especially during periods of excitement. But
if the alteration in the valves be such as to cause con-
siderable obstruction, or considerable regurgitation,
then serious palpitations talie place, and the extreme
danger of a gradually increasing hypertrophy of the
heart becomes established.

Diagnosis. — If there be fever, and especially if there
be rheumatic fever, with pain at the heart, and this be
followed by murmurs, the disease is in all probability
endocarditis : but it must not be forgotten that pain at
the heart, with excited action, may be accompanied by
murmurs, either hysterical or anaemic, or possibly mur-
murs may arise from spasmodic shortening of one of
the chordae tendinse, causing valvular regurgitation ;
further, the murmur heard may be of old standing — but
this is not usually so soft and blowing in character as
murmur recently produced. Further, if the deposit on
the valves be soft and smooth, there may be no appre-
ciable murmur, or the murmur may be hidden under
much pericardial effusion.

Endocarditis is to be distinguished from pericar-
ditis by the murmurs not being increased by pressure
with the stethoscope, by the pain being less acute,
and not increased by pressure, and by the absence
of friction sounds. On the other hand, endocarditis
and pericarditis more frequently coexist, as endo-
pericarditis, and loud pericardial friction may cover

ACUTE CARDITIS.

and obscure valvular murmurs, which murmurs it
should be remembered are to be listened for chiefly
over the aortic and mitral valves.

TREATMENT.

The Treatment, both allopathic and homoeopathic,
of this disease is exactly the same as that for pericar-
ditis, and I have no further observation to make, than
that I believe the formation of coagula in the heart,
secondary diseases in the lungs, liver, spleen, and
kidneys, met with under allopathic treatment, are not,
except in cases of a debased constitution, to be looked
for under homoeopathic treatment; and further, that,
especially, under the use of Aconite, valvular disease of
a serious nature, the result of endocarditis, is quite an
exceptional result.

The treatment of valvular disease, as a result of endo-
carditis, will come under the treatment of hypertrophy of
the heart.

In the 15th number of the f North American Journal
of Homoeopathy/ it is stated that out of fifty-seven
cases of endocarditis, treated by Dr. Fleishman, there
was only one death, and Spigelia was the only remedy
used.

ACUTE CARDITIS.

Acute carditis may be surmised more or less to
accompany every case of pericarditis and endocarditis ;
but idiopathic inflammation of the heart itself is so rare
a disease as to have come under the observation of very
few pathologists. Theoretically, the disease might lead
to general softening of the heart and local abscesses.

The treatment would be the same as for pericarditis.

THE HEART.

CARDIAC HAEMORRHAGES.

Cardiac hemorrhages, in tlie form of minute specks
over the surface of the heart, have been observed. In
some cases of pericarditis the effusion is sero-san-
guineous ; but this is chiefly in a scorbutic or debased
condition of the blood. Cancerous disease may be a
cause of haemorrhage into the pericardium. Rupture of
the coronary arteries, or the rupture of an aneurism,
or of the heart itself, may cause rapid haemorrhage and
instantaneous death.

The treatment of haemorrhagic pericardial effusion,
would be the same as for serous effusion, there being
no means of determining, during life, the nature of the
effused fluid, except by paracentesis, — an operation of
too serious a character to be undertaken experi-
mentally.

DROPSY OF THE PERICARDIUM.

Dropsy of the pericardium, apart from the acute
dropsy of pericarditis, may be a result of chronic peri-
carditis, or Bright’s disease, or general organic debility,
or from the mechanical obstructions of tumours or
ulcerations, cancerous or otherwise, or as a termination
of general dropsy.

Dropsy of the pericardium will furnish extended dull-
ness on percussion, and produce a sensation of weight.
If the dropsical effusion be considerable, there will be
a proportional bulging of the precordial region.

The treatment of pericardial dropsy will be the treat-
ment of the disease from which it proceeds ; but gene-

ATROPHY.

rally, blisters, cupping, salivation, diuretics, and purga-
tives are the allopathic resources.

The homoeopathic practitioner, -while he recognises in
pericardial dropsy a symptom often of fatal augury,
must yet necessarily reprobate the above treatment as
in direct violation of common sense. General debility,
or debilitating disease, being the main cause of pericar-
dial dropsy, the only true treatment must be either that
which is homoeopathic to the disease present, or such
general hygienic treatment as may enable the powers of
nature to overcome the disease.

Arsenic, Lachesis, Cobra, Digitalis, and Sulphur
may be used with advantage ; but I believe Arsenicum
in dilutions, rising from the 3° decimal to the 12° centes-
simal, is the remedy from which most is to be expected.
The question of paracentesis will be considered, in
extreme cases, as an expedient for temporary relief.

If the dropsy is not the result of some incurable
organic disease, homoeopathic and general hygienic
treatment may not only be pursued with confidence,
but will contrast very favorably with the result of all
depleting measures ; while,, even in hopeless cases, life —
which is certainly often manifestly shortened under de-
pletion— is under homoeopathic treatment sometimes
prolonged beyond the expectation even of the most san-
guine practitioner.

ATROPHY OF THE HEART.

Atrophy of the heart , in which the organ is dimi-
nished in size and w'eight, occurs in wasting diseases,
such as phthisis and cancer. It is also frequently a
result, more or less, of adhesion of the pericardium
after pericarditis.

T1IE HEART.

In sucli cases, there will be diminished percussion
dullness, and weakness of cardial action, with occasional
palpitations.

For this condition of things, the only line of treat-
ment that can be hopefully suggested is, to be as much
in the open air as the strength of the patient or the
condition of the atmosphere will permit, with gentle
horse or carriage exercise, and a nutritious but not a
stimulating diet.

HYPERTROPHY OF THE HEART.

The heart may be enlarged symmetrically in all its
parts, or the walls may be thickened, whereby the
cavities are diminished in capacity, or the cavities
may be distended, having walls of a normal thickness,
or the cavities may be enlarged with thickened walls,
or the heart may be enlarged in one part only ; and
when this is the case, the left ventricle is the usual seat
of such hypertrophy.

The heart may be enlarged to double or treble its
normal cubic capacity, and may be found to have in-
creased from eight to twelve ounces ; its normal weight
to twenty or thirty ounces.

Percussion may sometimes, in extreme cases, find the
boundary of the heart to extend from the second inter-
space to the eighth rib, and from two inches to the right
of the sternum to two inches and a half to the left of
the left nipple.

The cause of muscular hypertrophy of the heart is —
like that of other muscular development — excess of
action; and the following may be enumerated as causes
of heart hypertrophy. Nervous palpitations ; the over
stimulation of a full animal diet ; the free use of

HYPERTROPHY.

alcoholic stimuli ; and here we remark, that a gouty
habit often accompanies hypertrophy. Chronic bron-
chitis, emphysema of the lungs, or obstructive or regur-
gitant valvular disease, ' demanding extra action to
overcome obstruction, or to supply sufficient blood to
the circulation.

Further, heart hypertrophy is frequently begun at
school or at the university, by over-indulgence in all
athletic games, but especially at foot-ball, hare and
hounds ; and, perhaps, most of all, by boat-racing.

Those mechanical occupations also, which call for
laborious and powerful action of the arms, as with
paviors, often lead to hypertrophy.

But, of all causes, rheumatic fever, as leading to
valvular disease, must be accounted the chief cause in
leading to hypertrophy of the heart.

In this chapter, however, by hypertrophy, I mean
simple hypertrophy, independent of valvular disease ;
viz., a form of hypertrophy of rare occurrence, as com-
pared with that ensuing on valvular disease.

Physical signs. — If the hypertrophy be considerable,
there is bulging of the pericardial region, and increased
impulse against the chest walls. The impulse may be
so strong as to cause the stethoscope to bound for-
ward as it were, and to shake the patient, and even
the bed he lies on. The percussion dullness may
extend to two inches on each side beyond the normal
measurements. (See Diagram.)

I have recently met with two cases of hypertrophy
of the heart — one was general hypertrophy, producing
dullness over the entire middle posterior region of
the lungs; the other hypertrophy chiefly of the right

THE HEART.

ventricle, from emphysema, accompanied with dullness
of the base of the right lung, probably the result of
habitual congestion.

If the walls be hypertrophied while the cavities
remain normal in size, the first sound will be full,
and it may be murmurish from the violence with which
the blood is made to rush through the orifices. If,
however, the walls be hypertrophied and the cavities
diminished, there being but little blood to propel, the
first sound may be nearly inarticulate. If the cavities
be enlarged, and the walls hypertrophied or vigorous,
the clearness of the sounds will be increased; but
enlarged cavity, without proportionally vigorous walls,
will furnish feeble, dull, or muffled and prolonged sounds.

In short, the clearness and force, so to speak, of the
sounds, have more relation to the excitement or vigor
of the organ, than to the size of its parts. The left
ventricle is the chief seat of hypertrophy ; but, in
emphysema, the right ventricle only may be hyper-
trophied, producing a tendency to congestion of the
lungs from 1 engorgement, and lividity of the face from
the consequently retarded flow of venous blood.

In such cases the extended dullness on percussion
should be chiefly to the right, although this is uncertain,
as hypertrophy of the right ventricle may push the
heart to the left; but if there be a strong impulse,
and yet no correspondingly strong pulse — in the absence
of valvular disease — there is then ground to suspect
hypertrophy of the right ventricle.

Symjitoms. — If the heart be hypertrophied and active,
and there be no obstructive or regurgitant disease,
the pulse will be strong. The visage is often full; the

HYPERTROPHY.

complexion red; the eyes protuberant and lustrous;
the animal spirits active ; and, I think, the temper
often quick, and the general character energetic.

There may he throbbing headache ; and, from the
propulsive action of the heart being sometimes, as it
were, in advance of the capillary circulation, there may
be a tendency to brain and lung congestions, with
dyspnoea on sudden exertion. The liver, during such
exacerbations, especially as are caused by the obstructive
operation of a supervening attack of bronchitis, is liable
to temporary engorgement and enlargement.

The pulsation of the carotids, and sometimes also of
the smaller arteries, may be visible.

Palpitation also is a frequent symptom, and what
is called “ a tendency of blood to the head; ” this
being occasionally relieved by epistaxis.

Put there may be considerable hypertrophy, and yet,
under a quiet and temperate life, all unpleasant symptoms
may be habitually absent.

A short sympathetic or irritative cough is often
habitually present in hypertrophy, especially when the
individual takes exercise.

Prognosis. — Simple hypertrophy is a much more man-
ageable disease than dilatation or flabby or fatty heart,
and in cases even of considerable hypertrophy, without
valvular disease, if a quiet temperate life be led, few
unpleasant symptoms may show themselves, and life
is not threatened with abbreviation. But irregularity
of life, indulgence in alcoholic stimuli, or incautious
mental or muscular excitement, will be apt to call out
aggravated symptoms.

In any derangement to the circulation from over-

THE IIEA11T.

exercise or from an attack of acute bronchitis, there
will be clanger of brain and lung congestions, and, if
tlie attack be severe, dropsical swellings, beginning
about the feet, may show themselves.

TREATMENT.

Allopathic treatment recommends blistering, bleeding,
cupping, or leeching in aggravation ; also Digitalis,
Belladonna, and Aconite, together with purgatives.

The Homoeopathic treatment in this disease has this
decided advantage over the allopathic — 1st. That it
totally ignores bloodletting ; and, as an ansemic condi-
tion of the blood, such as bloodletting is apt to produce,
is one of the worst evilswhich can accompany hypertrophy,
and is itself sometimes a cause of hypertrophy; this
abstaining from bloodletting is a great gain. 2d. No
homoeopathic treatment, such as the Digitalis and pur-
gation of allopathy, can ever cause that nervous weak-
ness, which is both an occasional cause and a frequent
encouragement of hypertrophy, by inducing nervous
palpitations. 3d. I conceive our remedies not only
act with more success in the treatment of nervous-
ness, indigestion, and constipation, all tending to the
increase of hypertrophy, but the homoeopathic use,
especially of Aconite, Digitalis, Aurum, Lachesis and
Cobra, have specific effects, which I believe act with
better results than any allopathic medicines.

Aconite, Arsenic, Aurum, Belladonna, Bryonia, Coffea,
Digitalis, Hyoscyamus, Ignatia, Lachesis, Nux, Rhus,
Spigelia, are the chief homoeopathic remedies to be con-
sidered in the treatment of the various symptoms which

TREATMENT.

may arise in this disease, and such may often be adminis-
tered with most satisfactory results; e.cj. Coff’ea or
Aconite, in excitement; Bryonia or Rhus after over-
exertion, or if there be pain about the heart; Nux,
Bryonia, Sulphur, &c., in constipation, forcing at stool
being very injurious.

Hygienic treatment, however, is in this affection of
the first importance.

The diet must be simple and non-stimulating, all
excess must be avoided, animal food should be taken as
sparingly as the strength will permit ; also all food
causing flatulence must be avoided. Alcoholic stimu-
lants, tea and coffee, must be very sparingly used.

All excess in mental emotion must be guarded
against, and excessive bodily exercise must be carefully
avoided ; and, although hypertrophy, once established,
can probably never be eradicated, yet by a patient and
watchful control over the appetites and passions and
general conduct, hypertrophy, unless of great extent,
may become, as a disease, virtually non-existent.

The youth of Great Britain are the finest specimens
of juvenescence in the world; and much of the manly
beauty of their youth and the vigorous judgment and
sterling qualities of their manhood, are owing to the
love and laboriousness with which the boy, the youth,
and the man, cultivate all the active sports of the field,
the river, and the mountain heath. But, on the other
band, few sessions pass over at our great universities,
in which some have not sowed the seeds of incurable
diseases of the heart, from that excessive tension put
on the heart which inordinate boat-racing, especially,
produces ; and I think it may well be asked why the
noble athletic emulation of our youth should not be

THE HEART.

guided by men qualified to move and direct such opera-
tions in accordance with the laws of human anatomy and
physiology ? To direct the training of the body in accord-
ance with the laws of human development, and in such
a manner that robust health and manly beauty might be
best secured, would surely be an avocation not second in
dignity or usefulness to that of grinding into the brain
the routine of Latin verses or Greek verbs.

DILATATION OF THE HEART.

By this term is meant enlargement in the measure-
ments of the heart, with walls, it may be, of normal
thickness, but attenuated in relation to the extra size of
the cavities. Sometimes the walls may be actually
thinner than in the normal condition ; and, on the
other hand, the walls may be thicker than natural,
although still thin in relation to the size of the cavities.

The auriculo-ventricular valves may be rendered in-
competent by the enlargement and stretching of their
surrounding parts ; and in dilatation of the heart the
texture of the organ is usually of a deteriorated quality,
thus yielding to the pressure of the blood ; and hence,
resulting sometimes in aneurismal distension of parts
of the heart. Valvular obstruction may be a cause of
dilatation, but probably not unless the organ have a
flabby, inelastic texture, — true hypertrophy, not dilata-
tion, being the usual result of valvular disease.

DISTENSION OF PARTS OF THE HEART.

Physical signs. — In dilated heart, the form is gene-
rally altered from the pyriform shape to one more square,

DISTENSION OF HEART.

and the percussion dullness is therefore altered both in
outline and in extent.

The beat of the heart against the side is less definite
than either in health or in hypertrophy ; and the organ,
not having muscular power in proportion to its size and
weight, the action is more sluggish, and, as it were, of
a swelling character.

The sounds of the heart arc usually feeble, and some-
times so indefinite, that it requires considerable care to
distinguish the first from the second sound. In all
feeble action of the heart, the first sound, as it depends
chiefly on muscular force, is more impaired than the
second sound, which depends chiefly on the closing of
the semi-lunar valves.

The absence of murmur is no proof that valvular dis-
ease does not exist’, because the heart may be too feeble
to produce a murmur even with aortic obstruction.

Symptoms. — The symptoms of asthenic dilatation are
those of deficient power in the heart ; viz., an uneasy
sensation in the chest ; palpitations ; a feeble pulse,
which sometimes lags behind the systole of the heart ;
a dusky or patchy complexion ; blueness in the lips,
tongue, and fingers ; a general feebleness both of mind
and body, and disinclination to action and adventure;
dull headache and drowsiness; constipation of the
bowels ; watery look about the eyes. There is dyspnoea,
especially on ascending stairs or hilly roads, and there
may be a tendency to syncope ; a cough is usually pre-
sent, at first dry, but apt to be accompanied by expec-
toration, and often resulting in bronchial flux, from
retarded circulation through the lungs; and, as all re-
tardation through the lungs necessarily leads to conges-

THE HEART.

tion in the liver, this again becomes enlarged, especially
during paroxysms of dyspnoea.

The kidneys also become congested, and the urine
may be scanty, or even albuminous.

The ankles easily become oedematous, as during
a catarrh or after fatigue.

The diagnosis , from physical examination, between
hypertrophy and mere dilatation, may present some dif-
ficulty ; but m hypertrophy there is generally more
vigour of constitution, more vigorous propulsion of the
beat against the cliest-walls, and a stronger pulse ;
although in both forms of disease the first and second
sounds may be very ill defined, and both present ex-
tended percussion dullness.

Pericardial effusion will cause bulging and dullness ;
but percussion over fluid is more absolutely dull than
over solids, and, unless the pericardium be quite filled
with fluid, the region of maximum dullness will gravi-
tate according to the position of the patient. Fluid also
tends to raise the apex of the heart ; but in dilatation,
the apex is lowered.

The prognosis in dilatation of the heart is unfavor-
able in proportion to the extent of the dilatation, the
feebleness of the heart's action, and the amount of con-
gestion, habitual or occasional, which occurs in the
lungs and the liver.

The termination is usually, in exacerbations of dysp-
noea, accompanied by bronchial flux, and followed by
hydrothorax, or general dropsy, ascending from the
extremities — or death may be by syncope.

TREATMENT.

Allopathic drug treatment recommends the use of iron
as a general tonic, and Opium, Belladonna, and Aconite
in cases of excitement ; and Dr. Stokes highly lauds the
use of small doses of mercury in all cases where the liver
becomes congested. Taraxicum is also given for the
liver; while ether and other diuretics are given, if
general or local dropsical symptoms supervene.

The Homoeopathic treatment will embrace the use of
Aconite, Arsenicum, Cobra, Bryonia, Coffea, Digitalis,
Ignatia, Lachesis, Lobelia, Lycopodium, Mercurius,
Nux Vomica, Phosphorus, Pulsatilla, Rhus, Silicea,
Spigelia and Sulphur, Plumbum (in constipation). Of
these remedies, Arsenicum, Cobra, Digitalis, Lachesis,
and Nux Vomica, I believe, will be found most beneficial.
Cobra, Digitalis, and Lachesis, will exercise a specially
specific action over difficulty or excitement about the
organ.

Bryonia, Digitalis, and Arsenicum, will also be useful
in those bronchial difficulties which are so apt to arise ;
on the whole, 1 believe Lachesis, Cobra, and Arse-
nicum must be most trusted to.

No doubt the mercurial action on the liver, so
strongly recommended by Dr. Stokes, must often afford
striking relief in cases of exacerbations accompanied by
liver congestion. Yet the slower, but more enduring
action of Nux Vomica and Mercurius, is more to be
recommended, because the frequent use of mercury
must exhaust the energies of the liver, and ultimately
hasten that which it is meant to retard, bv irrecover-
able liver congestion, with general embarrassment of the
circulation, and its consequent dropsical effusions.

In the regulation of the condition of the stomach and

THE HEART.

the intestinal canal, I feel confident that the methods
practised by the homoeopathic practitioner will give
him a great advantage over those who rely on mer-
curial and purgative medicines.

The Hygienic treatment of this disease must he at
least not second in importance to the medicinal treat-
ment. The hygienic treatment aims at retarding the
progress of the disease, and at the prevention of exacer-
bations. The medical treatment chiefly endeavours to
alleviate exacerbations when they occur.

An individual afflicted with dilatation of the heart,
should, if possible, live in an elastic and moderately
warm atmosphere. He must keep himself warm, more
by climate and clothing than by active exercise. His
diet should be nourishing, digestible, and not large in
bulk ; he should avoid copious draught of fluid, and
he should never make a full meal. In cases not much
advanced, horse exercise may be advantageous, but in
severe cases, even carriage exercise may be found too
rough.

The position assumed in bed should be that which is
felt to be most comfortable, but the patient should not
rapidly rise from the recumbent to the erect position.

The bowels should be kept moderately open, if possi-
ble, by home-made brown bread, and all mental and
bodily excitement, and over-labour, must be avoided.

Shampooing and friction over the body; viz., passive
exercise, will often be found refreshing and invigorating,
and will assist the circulation of the blood. And the
right hand of the medical man, or the hand of a friend,
pressed firmly, yet gently, over the region of the heart,
will sometimes relieve either occasional palpitations as
they occur, or relieve the general feeling of uneasy

TREATMENT.

oppression in the cliest. The patient should cultivate a
quiet and peaceful life, and hear, with as much patience
and self control as possible, the afflictions put upon
him.

The hot-air bath, carefully taken, will be especially
useful, affording great relief to internal congestions,
and yielding that relief to the skin which, under the
circumstances, cannot be obtained by active exercise.

Under circumstances as favorable as the above, con-
siderable dilatation of the heart may be followed by
very few dangerous, or even painful symptoms; and
a peaceful and prolonged life be enjoyed.

SOFTENING OF THE HEART.

Softening of the Heart may be the result of endocar-
ditis or pericarditis, or general inflammation (a very
rare form of disease) of the heart, or typhus fever,
scorbutics, or fatty infiltration.

Softening of the heart is a general forerunner of
dilatation.

A soft or flabby heart will present weak and uncer-
tain pulsations and sounds.

The symptoms will resemble those of dilated heart,
with this chief exception, that, whereas excited action
must labour and distress a dilated heart, and aggravate
the symptoms ; where the heart is merely soft and weak,
excitement will often relieve the symptoms.

TREATMENT.

The treatment of flabby heart will be much the
same as that of dilated heart.

TIIE HEART.

The various symptoms must be treated as they arise.
The general treatment will consist in gently bracing the
system, by being as much in the open air as possible,
gentle pedestrian or horse exercise, especially in a hilly
country with bracing air, avoiding over-stimulation,
and partaking of a diet moderate in bulk, but chiefly
consisting of animal food and stale bread.

The cold shower bath, while the patient stands
ankle deep in warm water, and this followed by active
dry fraction.

Sea-bathing, if it can be borne, but in all diseases of
the heart swimming must be hazardous, and it is scarcely
necessary to remind the practitioner of the danger in
such cases, accompanying the use of ether, chloroform,
and other powerful excito-soporifics.

Calcarea, Silicea, Arsenicum, Nux Vomica, and
Sulphur may be employed writh the view of giving
increased tone to the heart. With this view I should
prefer the 6° centessimal dilution, and administer the
remedies nightly, for weeks at a time ; not, of course,
neglecting that remedy, which may be homoeopathic,
to any intercurring symptom which may present
itself.

INDURATION OF THE HEART.

Induration is a rare form of disease ; which, if it
occurred in any of the papillary muscles, might so con-
tract them, as to cause mitral incompetence.

Theoretically — Calcarea, Silicea, and Sulphur, might
be used under such circumstances.

Chalky deposits may be lodged in the tissues of the
heart, interfering more or less with the free contraction

FATTY ACCUMULATIONS.

of the heart; and, if deposited in the coronary arteries,
may interfere with the nourishment of the organ.

Should such be the case, the disease must be obscure ;
but fortunately, it is a result of extremely rare occur-
rence.

Theoretically, the treatment which is worthy of a
trial would consist in the use of Calcarea and Silicea,
and the use of a vegetable and oil diet.

FATTY ACCUMULATIONS.

Fatty accumulations under the pericardium, or among
the fibres of the heart are, on examination, frequently
found in those whose bodies generally have much fat de-
posited.

Such accumulations are said to be found chiefly on
the right side of the heart, and certainly the liver and
venous system, more than the lung and the arterial
system, is connected with the formation of fat.

Accumulations of fat in particular regions, or generally
over the surface of the heart, may mislead to the idea of
the presence of tumour or hypertrophy.

Except, however, in the aged, or when carried to
great excess, fatty accumulation does* not appear to
disturb or labour the heart’s action ; and this fact is
quite in accordance with what we observe in other
instances ; viz., that the presence of a decided tendency
to the accumulation of fat, docs not, in the youth of
either sex, seem to interfere with vigour of action ; but,
on the contrary, seems often to accompany a more than
usual vivacity of disposition.

The treatment for fatty accumulations about the
heart would be the same as for general obesity.

THE HEART.

I believe Calcarea, from the 6° to the 12° centessimal
dilution, is almost the only homoeopathic remedy which
has been persevered in with the object of reducing
fat.

In my paper on the “ Liver,” in the f London
Journal of Medicine/ for 1851, I attempt to prove
that the liver is the great creator of fat in animals;
and, if this be so, then Mercurius, biline, cod-liver
oil, and other remedies acting on that organ, might be
worthy of a trial, theoretically.

But, as a tendency to the formation of fat is more a
constitutional result, and a sign, so to speak, more of ex-
cessively good health than of weakness, the cure of this
tendency must be — by the use of medicinal substances
— not an easy matter. Still, the substitution of water,
as the only true stimulant to the liver, for the use of
alcoholic fluids, viz., the artificial stimulants of the
liver, is well worthy of persevering trial.

Lean meats also, such as fish, hare, wild game, with
cabbages, cauliflower or asparagus, together with the
sparing use of puddings and butter ; and the substitute
of brown, oat, or barley bread, for white bread.

An active life in the open air, especially in keen
climates, such as that of Scotland, is advisable, as
there seem to be fewer instances of fat individuals in
such climates.

Theoretically, the more clastic the air, the more
active will be the individual ; and, therefore, the more
oxygen must be breathed, and the thinner therefore
should be the individual.

The sweating processes of the water cure, as illustrated,
especially in the successful action of the water-belt in
fatty abdomen, should be considered.

FATTY DEGENERATION.

The hot air bath also controls very actively the accu-
mulation of fat.

FATTY DEGENERATION OF THE HEART.

In Fatty Atrophy, as distinguished from fatty deposit,
the muscular tissue is oily under the finger, and a
granular texture and oil globules are detected by the
microscope.

The texture of the heart appears pale, oily and
mottled. It may be normal in size, or smaller or
larger than natural, and in such hearts there is a
tendency to aneurismal dilatations.

Fatty atrophy is often found in phthisis, renal disease,
paraplegia, and other debilitating conditions, but it also
appears without other co-existing degenerations.

Albuminous urine is often present, and the patient
may be mis-treated for kidney disease.

This is a disease which attacks all classes, the over-
fed and the under-fed, and it is said to have a preference
for the male, and that after middle-life. This, again,
may be because the liver and kidneys of such are most
liable to disease.

All that is known of its pathology is, that it is a
disease of degeneration of muscular tissue ; yet, why
that degeneration should be fatty, or why attack of
all muscles, almost exclusively the heart, is not known.
The liver and kidneys are also often fatty; and it
appears to me that the term “ degeneration ” is not
purely correct, the truth rather being that the vital
powers do not appear to possess sufficient ability to
convert the pabulum furnished into a higher organiza-
tion than oil.

THE HEART.

The heart is more or less fatty in a large proportion
of all debilitating heart diseases.

It is a disease which furnishes no physical signs
peculiar to itself, but the heart so affected acts languidly
and produces sounds more or less inarticulate. It
must be a difficult matter to distinguish between flabby
heart and fatty heart ; possibly the co-existence of
degenerate kidney and enlarged liver, and especially the
presence of oil in the urine, might aid the diagnosis in
favour of fatty heart.

The symptoms are those of languid circulation,
dyspnoea, viz., a sensation of feebleness and faintness
about the heart, and a tendency to sighing, and to
“ sighing respiration,” and even syncope, especially on
the patient rising abruptly from the recumbent or
sitting to the erect position.

The pulsations, in extreme cases, may be as few as
thirty in a minute ; but fatty disease may exist to a
considerable extent, and the pulse be quick, with a
tendency to irregularity.

Those afflicted with fatty or other feebleness of the
heart should be watched, while labouring under
diarrhoea or other debilitating losses of fluids ; as fatal
syncope has often resulted from the patient himself
abruptly rising up or being abruptly raised by the
attendants at the bed-side.

A tendency to congestive headaches and somnolency
may accompany fatty atrophy of the heart.

The Prognosis in fatty heart, if suspected, it being a
disease which does not admit of certainty in diagnosis,
must depend chiefly on the nature and extent of the
symptoms. A feeble pulse below 50 wall require
watching:.

TREATMENT.

No doubt, as in atrophy of the heart, and much more
so than in dilatation of the heart, the disease may exist
to a considerable extent ; and yet, with carefulness, not
be productive either of much inconvenience or danger.
There must be, however, in advanced cases, a tendency
to syncope, more or less serious and complete. The
fear of sudden death sometimes accompanies this
disease ; and death itself, either from syncope or from
aneurismal rupture, is sometimes the result. Still this
fatal result, in most recorded cases, does not appear to
have happeued till advanced age, sixty-seven being the
average age of the cases recorded by Dr. Stokes.

TREATMENT.

The treatment of this disease must be much the same
as that for softening of the heart ; viz., a quiet life, with
a steady following up of a mild tonic and bracing
treatment; and in a life spent much in an elastic atmos-
phere, if the temperature be agreeable to the patient.
The chief reliance is to be placed in free oxydation of
the blood. Tunbridge Wells or Malvern, or the York-
shire or Surrey hills might be suitable residences.

Gentle horse, carriage or walking exercise also is
to be recommended. But the laborious climbing of
hilly roads must be avoided.

Theoretically I should employ Calcarea, and very
minute doses of cod-liver oil, — cod-oil not only being, in
a sense, homoeopathic to the disease, but fatty heart
being itself often a disease of weakened nutrition, there
is a double reason for making a trial of these remedies.

Fcrrum, Arsenicum, Baryta Carbonica, Manganese,
and Phosphoric vYcid are also recommended in both
fatty and flabby heart.

THE HEART.

TUBERCLE IN THE HEART.

Miliary tubercular deposit lias been found below the
cardial surface of the pericardium, and such may
produce friction sounds and pericardial effusion. The
occurrence is extremely rare, but it is easy to conceive
the irreparable mischief which active allopathic treat-
ment might produce, if put into force on the mistaken
view that the pericardial signs indicated a threatened
inflammation in that region.

Allopathic treatment recommends blisters, purgation,
diuretics and iodine ; but surely the treatment for such
would be that of tuberculization generally, viz., a total
absence from depletion, and the use of cod-liver oil,
Calcarea and Phosphorus.

CANCEROUS INFILTRATION.

Cancerous infiltration, or encephaloid formation,
either primary or secondary, may attack the heart.

If primary, pain may be the only symptom present ;
if secondary, and failing any positive signs ; the pecu-
liar cachexia of the disease will have shown itself
beforehand.

ENTOZOA IN THE HEART.

Entozoa have very rarely been found in the substance
of the heart ; but the existence of such, and the local
destruction of the heart's walls, followed by rupture
and instant death, although not beyond the limits of
recorded experience, is yet nearly unknown.

DISEASES OF THE VALVES.

DISEASES OF THE VALVES OF THE HEART.

Diseases of the Valves of the Heart either directly
obstruct the free circulation of the blood by constric-
tion of the outlets, or indirectly impede the circulation,
by permitting the regurgitation of the blood, the
result of incompetency of the valves.

Obsti'uctive disease may arise from deposits in the
margin of any outlet, or from contraction of these out-
lets, or from external pressure constricting the outlet.

Regurgitant disease may result from that incom-
petency of the valves, which is produced by deposit on
their free margins, or by puckering of the valve, or
agglutination between the valve and its attachments,
or by hypertrophy of a cavity, causing a patulous state
of a valve, or by the shortening of a papillary muscle ;
while all the above-mentioned causes of valvular disease
may directly or indirectly be produced by the effusion
of plastic lymph, the result of endocarditis.

Mitral regurgitation murmur is heard during the
systole, and best at the left apex ; and, if a murmur be
heard here, and not at the aortic orifice, we may be
certain that it is an organic murmur, and does not arise
from thinness of blood.

It is necessary to remember, that valvular disease
may be productive of no murmur during the quiet
action of the heart ; and Dr. Stokes mentions a case
in which post-mortem examination revealed the sub-
stitution of a smooth ring for the mitral valve, in
which case no murmur had been detected during the
latter period of life — the smoothness of the walls of
the opening being the probable explanation.

THE HEART.

The regurgitation of the hlood from the left ventricle
demands extra work from that part of the heart to supply
the circulation, and hence hypertrophy of the left
ventricle is the result to he anticipated. If this
hypertrophy has taken place, the apex beat will be
carried somewhat outwards and downwards, increasing
the area of percussion dullnes, and yielding an impulse
stronger than natural.

The pulse may be nearly natural, but there is
generally an irregularity both in its rhythm and force ;
it is also compressible. The pulsation is, at intervals,
sharp and quick — indicating a vigorous effort of the
ventricle to propel its contents, but the absence of
power to force the blood in a full current; and cases
have occurred, in which sixty pulsations at the heart
have only produced thirty pulsations at the wrist.

Mitral regurgitation must more or less obstruct the
flow of blood from the lungs — causing pulmonary conges-
tions, cough, dyspnoea, and bronchial symptoms, with
wasting expectoration ; and sometimes, also, the ex-
pectoration of red blood.

Mitral obstruction may be followed by no murmur,
the flow of blood into the ventricle being a quiet pro-
cess, as compared with the rush of blood during ventri-
cular contraction.

It may lead, however, to hypertrophy or distension
of the auricle ; and, like regurgitant disease, tend to
produce pulmonary congestions ; but, unless it co-exist
with mitral regurgitation — a frequent combination — it
is by no means so serious an affection as regurgitation.

Tricuspid regurgitation will be heard best at the right
apex ; viz., close to the ensiform cartilage. It is softer
in character than mitral regurgitant murmur; and is,

DISEASES OF THE VALVES.

indeed, frequently inaudible, owing to tlie comparatively
feeble power of the right ventricle ; and, as the left
ventricle is much more frequently the seat of endo-
carditis, valvular disease of the right side is proportion-
ably rare.

In this disease the jugular veins are often turgid and
pulsating, and there is a tendency to congestions of
the brain, and a condition of things favorable to apo-
pleptic symptoms. There is also the tendency to liver
congestion, and dropsical effusions may take place from
this cause, although no tricuspid murmur has been de-
tected, and thus the primary cause of the dropsy may be
undiscoverable.

Tricuspid obstruction is of rare occurrence, and
when present is seldom followed by any perceptible
murmur.

Aortic obstruction. If the action of the heart be
strong, aortic obstruction produces a loud murmur, and
a thrilling sensation during the systole — this thrill
being conveyed along the carotids, the murmur itself
having been heard, according to Dr. Stokes, as far as
the tibial artery.

This is the chief seat of their blood murmur, but the
absence of murmur at the mitral orifice will be an
evidence in favour of the murmur being organic — how-
ever, even at the aortic orifice, a feeble heart and a smooth
orifice may fail to produce murmur, although obstruc-
tion be present.

Hypertrophy of the left ventricle is the anticipated
result. The pulse may be normal, but is inclined to be
hard and sharp ; and, especially if there be hypertrophy,
the blood being squirted, as it were, with much force

THE HEART.

through a constricted orifice, will appear jerking at the
wrist.

Theoretically, obstruction at the aortic orifice should
produce a general retardation of the circulation, and
its consequent congestions ; but, practically, this position
of valvular disease is much less injurious than mitral
regurgitation, — probably because, although the cir-
culation be obstructed, yet the supply of blood is regular
and steady, and the bodily organs accommodate them-
selves to the condition present. The ultimate result,
however, is the danger of an ever increasing hyper-
trophy of the left ventricle. Still, with carefulness,
many years may pass over without any serious result,
or even oedema of the ankles supervening, and sudden
death from aortic obstruction is the exceptional ter-
mination in this disease.

Dr. Stokes gives the extraordinary history of a
gentleman up to a certain period enjoying good health,
post-mortem examination revealing an amount of aortic
constriction which admitted of the passage only of a
probe.

Aortic regurgitation, from incompetency of the valve,
will be followed by a murmur during the diastole, from
the contraction of the aorta, aided by the suction power
of the left ventricle, causing the aortic blood to rush
backwards.

Under these circumstances the action of the ventricle
must be laboured, and hypertrophy will be the result.

"When hypertrophy exists the pulse will be strong,
but abruptly short from the falling back of the current,
and thus jerking pulse is produced.

The symptoms will be analogous to those follow-
ing mitral regurgitation ; viz., pulmonary conges-

DISEASES OF TIIE VALVES.

tions; and the hypertrophy produced will sometimes
cause mitral regurgitation, from stretching of the
attachments of that valve.

Pulmonary artery. Obstruction at this orifice is of
rare occurrence, and obstructive murmur of still rarer
occurrence, — should it appear, it will be distinguished
from aortic obstructive murmurs by not being trans-
mitted along the aorta.

Theoretically, such an obstruction should produce
imperfect oxygenation of the blood — with blueness of
the skin, and coldness of the skin and breath — hyper-
trophy of the right ventricle, and an obstacle to the
venous and hepatic circulation ; but the fact itself being
rare, and when present, of difficult diagnosis, the
positive data in connection with this form of disease are
few, and clinically not very important.

Regurgitation from the pulmonary artery, during
life, is a fact which post-mortem examinations would
seem to have frequently indicated the probability or
reality of, but it is a fact which would seem scarcely
to have been indicated by any positive signs during
life.

The reason why murmurs have rarely been dis-
covered at the orifice of the pulmonary artery are :
1st, That inflammatory alteration of the pulmonary
valves is comparatively rare ; 2d, That the propulsive
power of the right ventricle is generally insufficient
to develop murmur, unless the blood be either thin,
or the surface over which it is propelled is hard and
rough.

THE HEART.

GENERAL DIAGNOSIS OF VALVULAR DISEASE.

In the diagram at the beginning of this book, I
have indicated the position of the valves of the heart,
but as valvular disease naturally tends to produce
various hypertrophies, and consequent displacement of
the normal position of the valves, the position where
the murmurs will be best heard, will not exactly cor-
respond with the position of the valves during health.

It is necessary also to remember, that loudness of
murmur is no certain index to the extent of the disease,
but depends more on the force of the heart, the thin-
ness of the blood, the thinness of the individual, or
the hardness of the obstructive deposits.

One murmur may cover or obscure another murmur ;
for instance, aortic constrictive murmur may cover
mitral regurgitant murmur, and render much careful-
ness necessary on the part of the stethoseopist.

Dr. Elliotson calls attention to the fact, that murmurs
sometimes vary in intensity, according to the position
of the patient favouring or impeding the action of the
heart, and also to the fact of a murmur being louder,
after tapping for dropsy, whereby the heart acted with
greater freedom.

The intensity of the symptoms will depend chiefly on
the extent to which the circulation is interfered with ;
and this, again, may depend on the seriousness of the
valvular disease ; or on the powerlessness of the heart to
contend with the valvular difficulties ; or on the condi-
tion of the other organs of the body; or on the mode of
life of the patient.

The chief symptom, viz., derangement of the circula-

GENERAL DIAGNOSIS OF VALVULAR DISEASE. 79

tion, will show itself in dyspnoea, palpitations, a ten-
dency to syncope, startings on falling asleep ; various
congestions of the head, lungs, and liver ; puffiness about
the eyelids, oedema about the ankles, an anxious expres-
sion about the eyes; or a peculiar complexion, either
mottled or having patches of fixed red.

Dr. Walshe places the danger of fatal results of val-
vular disease in the following order : — 1. Tricuspid re-
gurgitation. 2. Mitral regurgitation and constriction.
3. Aortic regurgitation. 4. Aortic obstruction.

In this arrangement, it is worthy of remembrance that
tricuspid regurgitation is placed as the most dangerous
form of valvular disease ; while we have seen that disease
of this valve is frequently productive of no murmur,
jugular pulsation being the only sign it may furnish.
Fortunately, tricuspid regurgitation is a rare disease, as
compared with mitral or aortic disease.

Theoretically, I should suppose coma, more than syn-
cope, the result of tricuspid regurgitation, and syncope
the result chiefly of mitral regurgitation ; and hence I
should have concluded that mitral regurgitation was a
more serious disease than tricuspid regurgitation, syn-
cope being a more rapid and less remediable cause of
death than brain-congestion or coma, — at least under
homoeopathic treatment.

Further, as disease of the mitral orifice is of more
frequent occurrence than disease of the tricuspid orifice,
we may suppose a larger number fall victims to the
former disease.

The general prognosis of valvular disease will depend
more on the urgency of the symptoms and the cha-
racter and life of the individual than on the loudness of
the murmur.

TIIE HEART.

No form of disease, one might a priori suppose,
should he more inimical to long life than severe chronic
dyspepsia — that is, deficient nutrition of the body ; and
yet it is proverbial that habitual dyspeptics are often
long lived — and why ? Because dyspeptics are com-
pelled to live quiet and steady lives, and to practise
great abstemiousness in eating and drinking. So also,
to a great extent, should it be with those having various
forms of disease of the heart.

These individuals are incapable of rashness in bodily
exertion, or of enduring excessive fatigue, and are predis
posed to quietness and temperance of life; and there
exists no reason why the life of a quiet man with consider-
able valvular disease should not be as good as that of the
average young and middle-aged men of this rapid age ;
and it appears to me that this view of the case is not
sufficiently considered by the medical officers of our
Insurance Companies.

The medical officer of an Insurance Company will in
the most summary manner reject the proposal, on ordi-
nary terms, of any man or woman in whom he can
detect the slightest organic heart murmur, but will
accept with avidity the offer of a robust fox-hunting,
or dashing and speculating City merchant, whose whole
character and life are fast, and whose chances of long
life may be very inferior to that of the temperate man,
whose heart is permanently affected by a long since
passed rheumatic fever.

It is true that valvular disease may be followed by
sudden death from syncope, but it is equally true that
the strongest and healthiest man on the earth may die
suddenly from apoplexy ; and every medical man must
have met with cases where habitual invalids, having

TREATMENT OF VALVULAR DISEASE.

been refused at Insurance Companies, liave yet long out-
lived the active, sanguineous, and rollicking young
friends of their early days.

This, at least, is certain, that it is a hard case that
those who have heart-disease should be precluded from
the comfort resulting from life-assurance on reason-
able terms; as the rejection, by acting with depress-
ing effect on the mind of the individual, must tend to
hasten any unfavorable result which may be conse-
quent on the disease.

The question is a difficult one ; but no body of men
should be more capable of solving the difficulty than the
medical officers of Insurance Companies, with the most
valuable statistical materials in their possession.

THE TREATMENT OF VALVULAR DISEASE.

The treatment of valvular disease is the same as that
of other heart diseases ; viz., first, the general restraint
and precautions to be practised by all in whom there is
any evidence of the existence of such disease.

Regurgitant disease must be a more serious affection
than obstructive disease, and must almost inevitably
lead, sooner or later, to hypertrophy somewhere.

Hypertrophy, indeed, in cases of valvular affection,
in one sense, cannot be so much called a disease as a
remedy for a disease, — that is, the heart having extra
work to perform, nature bestows upon her extra power ;
the misfortune being, that such extra power can scarcely
be attained except at the expense of extra bulk. But,
so long as this extra bulky organ does not interfere with
surrounding organs, or become tumultuary in its action,

8,2

THE HEART.

thereby disturbing tlie general harmony of the system,
little, if any, inconvenience will ensue. It therefore
becomes of the highest importance that no extra strain
be laid upon the heart by excesses, either of muscular
movements, of the table, or of other appetites or
passions.

Further, the quiet life demands so much less blood
circulation than the excited life, that normally incom-
petent valves may yet scarcely be reckoned as incom-
petent in relation to the work demanded of them by
the individual leading a placid life.

By these observations it is not, of course, meant to
be denied that the presence of disease in the heart is a
condition, which the supervention of other diseases,
such as bronchitis or congestion of the liver, -or the
accidental occurrence of sudden emotions, may not
call into serious, and even fatal prominence.

Allopathic treatment recommends, in cases of excite-
ment, occasional leechings and even bleedings; but as
any approach towards an ansemic condition of the
blood must be a serious aggravation of the disease,
demanding extra work from the heart, and causing
palpitations, it follows that all bloodletting, if a
substitute can be found, must be strictly forbidden;
and it is sufficient to add that Homoeopathy, in the use
of Aconite, has more than a substitute for bloodletting.

So, also, with reference to emetics, sometimes
recommended in derangement of the stomach. Homoeo-
pathy, in the use of her numerous medicines, having
control over stomach derangements, must surely possess
great advantages over the coarse, and even dangerous
action of emetics. Although it is not denied that
vomiting produced, if possible, by tickling the feuces,

TREATMENT OF VALVULAR DISEASE.

mav occasionally be necessary in cases where the

V V v

individual has grossly overloaded his stomach with food
or drink, and immediate relief is demanded.

The mild laxatives recommended by Allopathy do
not, at first sight, appear so objectionable ; but, as all
laxative medicine is followed by reaction, it must be a
great advantage if the Homoeopathic practitioner can
keep the bowels regular by the use of a suitable diet,
and his ordinary remedies for constipation, and this he
can do in the majority of cases which come under his
treatment.

In cases complicated with aummia, allopathic doses
of iron arc said to be “imperatively called for;” but
can such be given without the danger of producing
that congestion of the brain and constipation of the
bowels which, under Allopathy, calls for purgation, and
perhaps cupping ? I believe not ; and therefore anannic
palpitations must be controlled by avoiding all over-
excitement of mind or body, and the administration of
such homoeopathic remedies as act on the nervous
system, the stomach, the bowels, or the uterus, accord-
ing to the symptoms present.

Issues and Setons are even recommended, and that
even by the mildest of allopathic practitioners.

It is scarcely necessary to enter into the considera-
tion of remedies so gross and barbarous, the application
of which can only be followed by that distress and
excitement of the system which, of all things, is to be
avoided.

The diet to be avoided is, all food likely to cause
flatulence, such as fat, new potatoes, bottled beer,
soups, or any other thing which the experience of the
patient may have discovered to be indigestible.

84.

THE HEART.

Attention, more to simplicity and moderation than
to monotony and total abstinence, is to be cultivated.
Tea and coffee excite the heart through the nervous
system, and must be avoided if experience shows them
to be prejudicial — yet the moderate use, especially of
tea, is on many occasions soothing, refreshing, and
salutary.

As climbing stairs labours the action of the heart
more than almost any other moderate exercise, a system
of pulleys has been recommended to hoist those who
have palpitations up to the bed -room floor. Very few
houses, however, admit of any such arrangement ; and,
besides, the nervous excitement accompanying the
suspension in the air I should suppose would cause
palpitations equally severe. It is better, when the
climbing of stairs is severely felt, that the patient
should, if possible, either be carried up-stairs, or rather
that he should sleep on the first-floor — that is, if the
ground-floor is felt to be dull and depressing.

The special homoeopathic remedies recommended, are
the same as those mentioned under the treatment of
hypertrophy, dilatations, -palpitations, &c. ; and any
one practically acquainted with homoeopathy well
knows the invaluable services rendered in such aggra-
vations of heart disease as bronchitis, pulmonary
congestions, head congestions, palpitations, cedemic
swellings, constipation, and nervous excitement and
palpitation, by the employment of such remedies as
Aconite, Bryonia, Arsenicum, Belladonna, Coffea,
Digitalis, Ignatia, Pulsatilla, Lycopodium, Nux Vomica,
Mercurius, Opium, Phosphorus, Spigelia, Lacliesis, and
Cobra.

But especially, so far as my experience goes, in the

CYANOSIS.

use of Arsenicum, Phosphorus, Nux Vomica, and more
especially still in Cobra and Lachesis.

CYANOSIS.

Cyanosis, (kvcivo?, blue,) or “ the blue disease,” may
be caused by anv anatomical conditions which prevent
the blood from being sufficiently oxygenated, as
in stricture of the pulmonary artery, or the aorta
arising from the right ventricle, or communicating 'with
the pulmonary artery, or ulcerative communication
between the right and left ventricle, whereby the
arterial and venous blood are mixed in the circulation.
The common cause, however, is the foetal mechanism of
the foramen ovale remaining permanently open, and
the blood of the general circulation being mixed venous
and arterial.

It is said that post-mortem examination has been
made to reveal open foramen ovale, and yet no blueness
was discovered during life. In such cases the foramen
ovale was most probably either almost closed or pro-
tected in some manner during the contractions of the
ventricles. Indeed, it is easy to conceive that, owing
to the construction of the ventricles adapted to propel
the blood along the aorta and pulmonary artery, very
little mixture of blood between the two ventricles might
take place.

The symptoms are blueness or darkness of the skin,
and especially of the face, tongue, and lips — a tendency
to oedema of the feet — dull congestive sensations in
the head — a general lethargy of habit — coldness of
the surface and of the breath— liability to dyspnoea,
especially during mental emotion or over exertion — a
tendency to syncope and semi-coma.

TIIE HEART.

Of seventy-one recorded cases, it is said, tliat the
symptoms of only forty were manifest at birth; and
the explanation given is, that the patency of the foramen
ovale increased with years ; or that the blueness did not
result until, with advancing years, the circulation, from
chronic bronchitis or other causes, became more and
more embarrassed.

Cyanotic blood would appear to offer some protec-
tion against the growth of tubercle. Of this we shall
speak further in treating of phthisis ; but, as a disease
existing in the adult, and leading to blueness of the
skin, it is certainly not often met with, if one may trust
to casual observation in millions of cases in the streets
of London.

The treatment of this disease will consist mainly in
the patient’s living a quiet life, in keeping the body
sufficiently warm by clothing, and in avoiding any
overloading of the stomach. But, mainly, where prac-
ticable, in the patient living almost entirely in the
open air, of a mild climate, whereby the blood may
become as much oxygenated as possible.

The liver, head, and lung congestions, which are apt
to arise in this disease, must be treated by the appro-
priate homoeopathic remedies, of which it may be
sufficient to enumerate — Bryonia, Carbo Vegetabilis,
Lachesis, Nux Yomica, Mercurius, Opium, and Phos-
phorus.

RUPTURE OF THE HEART.

Rupture of the Heart and fatal haemorrhage into the
pericardium, is that terrible catastrophe which has
occasionally followed softening of the heart, fatty in-
filtration, aneurismal dilatation, or ulceration.

The left ventricle, as might be presumed, from its

RUPTURE.

superior force of action, is the part which has furnished
most cases of this kind, and such have been chiefly in
advanced age, and during fits of passion, or, while lifting
heavy weights. A blow has also caused the accident.

Death is usually either instantaneous, or within a
very brief period of the accident; but Dr. Walshe
narrates the painfully interesting case of a man, aged
forty-eight, with hypertrophy of the heart, &c., who
was seized with sensations of extensive restlessness and
anxiety, cold, clammy sweats — gradually in creasing faint-
ness, and dyspnoea and coldness, and ultimately death
in thirty-six hours. The post-mortem examination
revealed about two ounces of blood in the pericardium,
which had escaped from an opening not bigger than to
admit an ordinaiy sized pin. This is a singular case —
the smallness of the fissure is singular, and death
resulting after the loss of only two ounces of blood
is more so. Indeed, the suddenness of death resulting
from rupture is not altogether accounted for — as the
pericardium being of limited extent the mere loss
of blood cannot be the chief cause, the shock to the
system must be equally important.

I am not aware that any case is recorded where
rupture of the heart has terminated otherwise than in
death ; although, it does not seem impossible that with
perfect quietness, the employment of Aconite internally,
and, perhaps ice externally, over the heart to allay excite-
ment of that organ, together with the use of Arnica,
might not lead to the fibrinous closing of a small
aperture-

The chances of so happy a result would, however,
be greater in traumatic rupture or wound, than in
rupture from ulcerative or fatty disease.

TIIE HEART.

The sudden rupture of the chordae tendinse, papillary
muscles, or of a valve of the heart, has occurred during
violent passion, or extreme muscular exertion.

The immediate result is pain, palpitations, a tendency
to syncope, with coldness, pallor, and deep mental
anxiety. Under this circumstance, a patient of Dr.
Stokes exclaimed, “ my heart has broken.” Sudden
death has also resulted from the accident. The reason
why at one time there is merely an aggravation, it may
be, of the previous symptoms of hypertrophy, and at
other times, sudden death, must probably come under the
category of “ accidental.” The result is the sudden pro-
duction of that which, in other cases, is produced gra-
dually, viz., patency of the valve affected, and conse-
quent^ regurgitant disease. In almost all cases it is
the papillary muscles attached to the mitral valve which
give way. Atheromatous deposit being often found
in the broken papillary muscle.

The sudden appearance of a murmur following the
above symptoms should be conclusive proof of the
nature of the accident.

The treatment of symptoms as above, would be to
place the patient in a comfortable bed, to soothe as much
as possible by quieting the mental anxiety, and by
gentle frictions over the region of the heart.

Aconite, Lacliesis, and Arnica, are the medicines
which would be considered.

ANEURISMAL DILATATION OE THE HEART.

Aneurisma! dilatation of the heart is an occurrence
confined almost entirely to the left ventricle. In some
cases it may be regarded in the light of local hyper-

PULSATING AORTA.

trophy; but it usually arises from a soft and yielding-
condition of the heart’s substance, — being, however,
sometimes more properly aneurismal ; that is, arising in
the first place from ulceration of the endocardium.

It occurs in males chiefly ; and the first indication of
it is frequently found after violent bodily and mental
action.

If the dilatation be small, the signs and symptoms
may be unmarked ; but if considerable, they will be
those of ordinary dilatation.

Death may result suddenly from rupture ; but more
generally the patient suffers from a gradual wasting, as

in ordinary dilatation of the heart.

The treatment is the same as for dilatation; viz., great
carefulness and prudence, and the employment of such
remedies as have been recommended in exacerbations,
viz., palpitations or mental excitement, attention being
paid to the condition of the stomach, bowels, and liver.

COAGULA IN THE HEART.

Coagula are sometimes formed within the heart in
pneumonia and cholera, but chiefly in endocarditis, and
such may cause murmurs, by preventing the closure of
the valves.

I believe, however, as I have before observed, that
such coagula are frequently the result of depleting
measures, and that, under homoeopathic treatment,
their occurrence must be extremely rare.

THE HEART.

DISEASES OF THE AORTiE.

PULSATING AORTA.

As we "have nervous palpitations of the hearty so also
we meet with inorganic abnormal pulsations in the
course of the thoracic and abdominal aorta. We occa-
sionally find such in cases of anaemia, hysteria, spinal
irritation, ovarian disease, haemorrhoids, nervous debi-
lity, dyspepsia, and flatulence; and also in cases of
pressure on- the artery, from tumors and enlarged
organs ; and also in the neighbourhood of inflamed
parts.

The sensation is extremely disagreeable to the pa-
tient, and may mislead the medical attendant into the
belief of the presence of aneurism.

Like nervous palpitations of the heart, it has often a
close connection with the action of the sympathetic
nerve.

The pulsations may produce sensations of faintness
and sickness, and they are visible in the epigastrium
and at the umbilicus, synchronous usually with the
action of the heart, and usually unaccompanied by any
murmur.

The diagnosis from that nervous fluttering, at the epi-
gastrium and elsewhere, so frequent in nervous patients
is not difficult ; but it may be difficult to distinguish
inorganic pulsations of the aorta from aneurismal
pulsations; and especially if the aorta be pushed for-
ward by any sub-latent tumor, or if any soft tumor
lie on the pulsating artery. We may be assisted by
the fact, that aneurism is more common in the
male, pulsating aorta in the female; the pulsations

ACUTE AORTITIS.

of aneurism are also more heaving in character, while
pulsating aorta is more liable to interruptions. There
is often, also, an aspect of organic disease in aneurism,
and of nervous excitement in pulsating aorta.

Allopathic treatment recommends Assafoetida, Co-
nium, Hyoscyamus, Lettuce, Hydrocyanic Acid, leeches,
dry-cupping. Belladonna plaster, and Morphia endemi-
caliy, &c.

The homceopathist will employ chiefly Aconitum,
Aurum, Belladonna, Hyoscyamus, Ignatia, Barytes,
Coffea, Xux Vomica, Pulsatilla, and Lachesis.

The diet must also be alluded to ; tea and coffee had
better be discontinued for a time, and sponging or the
shower bath be put in operation. The sitz bath will
also, especially in cases of liver congestion, haemorrhoids,
or uterine irritation, be very useful. The smoking of
tobacco must be discontinued.

As this is a disease mainly depending on some de-
rangement in the digestive system, the homoeopathist
may well anticipate a success more flattering to his
system, than the allopathist with his stomach-deranging
drops is likely to meet with.

ACUTE AORTITIS.

Acute Aortitis is a form of disease not often met with,
but -when it occurs is ushered in with rigors and pain
in the course of the artery. If lymph be deposited,
there will be a murmur produced ; but it must be re-
membered that a murmur heard in the course of an
artery may be by conduction from the heart, and it is
said such may be heard even as far as to the popliteal
artery.

THE HEART.

The symptoms of acute aortitis are said to resemble
those produced by an animal poison ; viz ., great fever
and restlessness, oedemic swellings, a dusky complexion,
and a general cachexia, together with pain in the
region of the spine, over the aorta.

Allopathy recommends active general bleeding or
cupping in the course of the artery, and blisters, fol-
lowed by the endemic application of mercury or morphia.

Homoeopathy will trust to Aconite, Arsenicum, Cobra,
and Lachesis, with hot water fomentations down the
spine.

As acute aortitis is a disease which must be of difficult
diagnosis, especially in its early stages, which may be
simulated by neuralgic affections ; it is evident that the
heroic practitioner, by over anxiety to follow the routine
of the schools, might very easily be led into an activity
fatal to his patient.

Chronic Aortitis is a name given to explain that which
is sometimes met with in post-mortem examinations;
viz., vascularity or fibrous contractions, or roughness
of the lining membrane of the aorta, or puckering of
the aorta itself.

But no records of the treatment of such a disease
during life are given, and it is somewhat singular that
so active an inflammatory agency should occasionally
be at work without producing symptoms of a corres-
pondingly acute character.

ATHEROMATOUS DEPOSITS IN THE AORTA.

Atheromatous and chalky deposits may take place in
the aorta; and although such, of themselves, will pro-
duce neither symptoms nor physical signs, unless carried

CONSTRICTION OF TIIE AORTA.

to tlie extent of producing constriction of the aorta,
ivliich again would he followed by murmur — yet, in
relation to the liability to the formation of aneurism,
such deposits are deeply important.

CONSTRICTION OF THE AORTA.

Congenital constriction of the arch of the aorta, at the
part where it is joined by the ductus arteriosus, has been
observed after death in a small number of cases ; and it
is a most extraordinary fact that almost total closure of
the aorta at this position has existed, and yet produced
no appreciable clinical signs. Dr. Stokes, p. 153, nar-
rates an extraordinary case, where, up to the period of a
fatal illness, a gentleman enjoyed good health, and yet
post-mortem examination revealed a constriction at the
aortic valve, so great that it could admit only a small
probe.

Cases of this kind are in one sense very encouraging,
as they prove how wonderfully nature may accommodate
herself to circumstances ; and also that good general
health may be enjoyed, notwithstanding an extraordi-
nary amount of heart disease. As quoted by Dr.Walshe,
“ Of sixteen persons dying with such stricture, two
were under ten years of age, eight between ten and
forty, five between forty and sixty, and one between
sixty and seventy.”

But although good health has been enjoyed under
such circumstances, and the condition of the lower part
of the body and the lower limbs not materially affected,
yet rupture, we may suppose, might readily take
place at the stricture on violent action of the heart.
Excessive pulsation in the carotids — enlarged from the

9-1

THE HEART.

extra stress put on tliem — might he anticipated, and a
murmur and thrill having their maximum ove%the seat
of the stricture, viz., at the second right cartilage.

Stricture of an inflammatory origin may occur at
different parts of the aorta. The aorta in its entire
length may he much reduced "below its nominal calibre,
by any cause diminishing the bulk of the blood circu-
lated, as mitral or aortic valvular constriction ; or as in
phthisis and other debilitating diseases.

ANEURISM.

Aneurism (avevpvvio, to dilate) signifies a local dila-
tation of the artery, occurring either at one side of the
vessel or in its entire circumference. This dilatation
may implicate all the coats of the artery, viz., the
internal coat, the middle elastic coat, and the external
fibrous coat ; or it may be, that a perforation of the
inner, or inner and middle coats has occurred, through
ulceration, or calcareous or atheromatous weakness,
whereby the blood escapes and dilates the external coat
by the direct pressure of the blood ; or, indirectly, by
successive deposits of coagulated blood in the sac of the
aneurism.

Anatomists have given several ambiguous names to
characterise aneurisms, according to the form and
method of the dilatation, or the coats of the artery
implicated ; but, for all practical purposes, aneurism in
the thorax is a dilatation of the aorta, which, if it
remain small, may furnish neither physical signs nor
pathological symptoms ; but which, if it go on enlarging,
must ultimately kill the patient, either by its pressure
preventing the circulation in the surrounding parts ; or

ANEURISM.

by the general cachexia produced by continual irrita-
tion ; or by rupture of the aneurism itself.

Aneurisms of the arch of the aorta may vary in size
from a filbert to a cocoa-nut ; and are usually filled,
more or less completely, with laminated coagula.

An aneurism may grow inwards, viz., concentrically ;
or outwards, viz., excentrically. Excentric aneurisms
are usually the largest, as time is given for their growth.
Concentric aneurisms generally in a shorter time ter-
minate fatally by pressure on vital organs.

Aneurism of the arch may cause pressure on, or de-
trusion of, the trachea, or oesophagus, or of the heart
itself ; bulging of the sternum, or of the clavicles, or of
the ribs ; pressure on the vena cava, or on the pneumo-
gastric nerve, or on the lungs, or the thoracic duct ; or
pressure on the main bronchi.

Physical signs. — There may be very great enlarge-
ment of an aneurism without much external bulging,
the enlargement being chiefly lateral; but excentric
pressure will cause a gradually increasing local bulging
of the chest, which bulging ultimately, if the pressure be
great, becomes red and shining. The pulsations of a
large aneurism are easily felt and seen ; and, if thick
laminse do not lie between the blood and the finger, ex-
ternally applied, a wavy sensation will be communicated.

The percussion dullness will be found over the arch
in front, and between the shoulders ; but the superficial
extent of this dullness is not always a measure of the
amount of dilatation, as a large globular aneurism may
only touch the chest-walls over a small space.

Dr AY al she records his having diagnosed, by percussion,
an aneurism as small as a walnut ; but this was a sue-

TIIE HEART.

cess much, beyond what can be calculated on in the case
of tumors so small.

In percussing over aneurism, gentleness and careful-
ness must be observed.

Auscultation. — The sounds heard over aneurisms are
manifold. Generally two sounds are heard, like the two
sounds of the heart, viz., synchronous with the propul-
sion of blood into the sac, and with the exit of a portion
of that blood when, from its elasticity, the sac contracts.
A rough “ hoarse ” murmur is heard, if the blood is
propelled into the sac with force through an aperture
moderate in size, or rough. This murmur will be louder
if the heart be hypertrophied or the blood anaemic. On
the other hand, if the heart be feeble, and the entrance
to the sac smooth, the murmur may be scarcely, if at all,
audible ; the entrance to the sac may be also tempora-
rily closed, in which case there will be no murmur ; or
the sac may get so filled with coagula, that no murmur
or sound may be heard.

Pressure on a main bronchus may diminish or sup-
press all respiratory sounds in the lung communicating
with that bronchus ; and a portion of a lung may col-
lapse, from the obliteration by pressure of its bronchi.

Turgescence of the veins of the face and neck may be
caused by pressure on the descending cava, and the
brain thus become congested.

Stridulous breathing may also be caused by pressure
on the main bronchi, and aphonia has occasionally been
produced; but both these symptoms may appear and
disappear within twenty-four hours, — a result which
could not occur if the symptoms were from cancerous
pressure.

ANEURISM.

Symptoms. — If tlie aneurismal tumor cause no pain,
and do not by pressure interfere with the action of the
veins, arteries, thoracic duct, or bronchi, there may be
little or no derangement to the general health.

But pressure on the spinal cord or the intercostal
nerves, will cause a wearying pain ; while pressure on
the vena cava must cause liver and other congestions.
Pressure on the bronchi may cause much dyspnoea ; and
pressure on the thoracic duct may interfere with the
nourishment of the body, and cause emaciation.

In fits of dyspnoea the patient instinctively raises his
shoulders, so as to lift the tumor, as it were, from off
the trachea or bronchi ; and, as in disease of the heart,
this mechanical cause of dyspnoea will cause the sleep
to be fitful and restless; but even during sleep the
patient will assume that position most convenient for
respiration.

As in heart-disease, the expression is anxious ; and if
there be pain from the pressure on any nerves, the
temper may be irritable; and during fits of extreme
dyspnoea, the expression is most anxious and imploring.

Dysphagia will exist if there be pressure on the oeso-
phagus; but the amount of this difficulty will often
depend on the amount of irritation it causes, more than
on the amount of pressure. “ A slight pressure will
produce greater difficulty with some, than even perfora-
tion will with others.

Phlegm, white, yellow, or muco-purulent, will be
expectorated if there be bronchial pressure.

Phlegm and blood will be brought up from the sto-
mach or the lungs, if there be perforation of the trachea
or oesophagus, and blood may pass by the stools.

The cough will be loud and clanging, with or without

THE HEART.

expectoration, if there he pressure on the trachea,
bronchi, or on the pneumogastric nerve ; while the voice
may be coarse and rough; or aphonia may be produced.
The cough is often most severe in the morning ; viz.,
after the nightly accumulation of phlegm. It may be
short, dry, and irritating ; or paroxysmal. Blood may
occasionally appear with the cough, either by direct
exudation from the aneurism or from congestions of the
small vessels. Blood in large quantities may come sud-
denly with the cough, and may produce syncope, while
the aperture may for a time become closed by a clot.

Pain down the back and arms, with tingling in the
fingers, will follow pressure on the spine or brachial
nerves.

Ulcerative absorption may take place in the vertebrae
or in the chest- walls ; and paraplegia has been the result
of vertebral injury.

The sensation of dyspnoea is a very general symptom,
and is referred by the patient generally to the position
below the sternal notch.

In what is called desiccating aneurism, viz., when the
inner coat of the artery is suddenly ruptured, blood may
be forced out between the inner and outer coats of the
artery. Sudden faintness, and perhaps syncope, will
result without any visible cause; but the most unfa-
vorable prognosis would be justified.

The prospects of the unhappy individual afflicted with
aneurism are of a character peculiarly solemn. The
course the disease naturally takes, is slowly and steadily
to expand until rupture finally takes place. But aneu-
risms may be more or less latent ; that is, from their
smallness, or from the direction of their growth, they
may not interfere with surrounding organs, so as to

ANEURISM.

cause any marked inconvenience. Sucli aneurisms may
suddenly expand, from the giving way of one of the
coats, and the worst symptoms become suddenly de-
veloped.

Death may result from the gradual wasting of the
system, from loss of sleep, irritation, and cachexia ; or
from pericarditis, bronchitis, pneumonia, or gangrene ;
or from asphyxia, — nil the result of pressure ; or from
rupture of the sac. In twenty-four cases out of twenty-
five, rupture, when it takes place, is internally — either
into the trachea, oesophagus, or mediastinum.

In rare cases, aneurism has burst into the vena cava,
or into the heart itself. Death has also resulted from
syncope, without rupture.

Aneurisms, like heart hypertrophy, occur chiefly in
robust muscular subjects; and, according to Roketansky,
TValshe, and others, those liable to tubercle are only in
a small proportion of cases amenable to aneurism. Dr.
Stokes, however, says that tubercle is frequently met
with in those who die of aneurism.

This partial incompatibility between phthisis and
aneurism, may possibly result from a certain antagonism
between the causes which lead to these two diseases; but
it may be no more than an illustration of the fact that
two different organic diseases seldom coexist in one
subject. In further explanation appears the fact, that
sixty-three per cent, of phthisical cases perish before
their thirtieth year, while in aneurism eighty-seven per
cent, die above their thirtieth year.

The lifting of heavy weights is not an uncommon
cause of the sudden rupture of aneurism ; and the lifting
of heavy weights, blows on the chest, or violent exertion,
has been sometimes supposed to originate aortic ancu-

100

THE HEART.

rism by rupturing one of tlie coats of the artery, or
originating local strain and weakness.

The diagnosis of aneurism of the arch of the aorta
will be chiefly in the existence of pains in the thorax,
and dyspnoea (the heart and the lungs being sound), or
a pulsating tumor in the thorax. The pulsation may be
scarcely perceptible, or it may be very evident, with or
without signs of pressure. Cancer is the most probable
cause of thoracic tumor ; and cancerous, tubercular, or
any other tumor, lying in contact with the heart or
aorta will pulsate ; abscess in the mediastinum will
also pulsate ; localized empyema, if near the heart,
may pulsate; and, being fluid, may closely resemble
aneurism. Abscess of the liver may also pulsate, and
the possibility of highly pulsating aorta from functional
causes must be remembered ; also, that in aortic regur-
gitation there is a jerking action of the aorta.

But the pulsations of an aneurism will generally,
especially if there be laminte, be more distinct and
regular than those from collections of fluid ; and solid
tumors will yield a less putty-like percussion dullness
than aneurisms yield.

Further, over aneurisms we may often find the
double murmur of the entrance and exit of the blood,
synchronous with the heart's action.

The history of the case will also assist in forming an
opinion as to the presence or absence of tubercle or
cancer; and tubercle, if in the mediastinum, may be also
expected at the apex of one or both of the lungs. The
difficulty will be great, if, from the smallness of the
aneurism and its silence with reference to murmurs,
there be no physical signs present ; but perhaps only
persistent anomalous sensations or symptoms in the

ANEURISM.

101

chest, — while aneurisms have burst and instantaneous
death has followed, there being no previous suspicion of
aneurism.

Hypertrophy of the heart, or fluid in the pericardium,
may produce symptoms like aneurism, but will not
yield dullness in the position of aneurism of the arch,
nor the murmurs of aneurism. Murmur heard with
greater clearness between the scapulas than over the
thorax, is probably aneurismal.

A currant-jelly-like expectoration or haemoptysis
accompanying a pulsating tumor, is in all probability a
proof of aneurism, especially if no malignant cachexia
exist.

It must not be forgotten that, from fibrous or other
plugging of the entrance to the aneurism, there may
be for a time no pulsation or murmur present.

The comparative latency of some aneurisms, and the
anomalous circumstances sometimes attending it, were
painfully illustrated ten years ago, in the illness and
death of Mr. Liston, the surgeon. This gentleman
one morning suddenly brought up about a quart of
blood, but in a few days afterwards resumed his usual
avocations, and subsequently performed, on horseback
and otherwise, some of those athletic exercises for which
he was famous ; and his death, which followed in a few
weeks, was not from a second rupture, but from gradual
prostration of strength.

Dr. Stokes, p. 582, gives the wonderful history of a
supposed aneurismal tumor, which often bled exter-
nally and profusely, and at the end of a year the patient
was lost sight of. In two other cases there were, at
intervals of several days, successive gushes of blood
before the fatal ultimate result.

102

THE HEART.

Aneurism, of the innominate artery will occupy a posi-
tion behind the inner end of the right clavicle ; and,
being nearer to the surface of the thorax than aneu-
rism of the arch, will generally be recognised earlier.

Aneurism of the descending aorta, if of sufficient size,
may be recognised by percussion in the region of the
spine, where also the murmur may be heard, and where
may be experienced a throbbing, gnawing pain, if the
pressure be considerable. Dysphagia also will be pre-
sent, if there be pressure on the oesophagus.

Hypertrophy of the heart is a condition furnishing
physical signs analogous to those of aneurism in this
position.

Aneurism of the pulmonary artery has been observed,
producing prominence, pulsation, and thrill between
the second and third cartilages on the left side ; but
aneurism of the transverse part of the arch, or hyper-
trophy of the left auricle, or other tumor in this region,
may furnish like signs.

Aneurisms pointing externally are not, as a rule, so
quickly fatal as concentric aneurisms, because the vital
organs are not so much interfered with ; and also
because, by careful external pressure, the growth of the
aneurism may be to some extent controlled.

An aneurism once formed must always subject the
patient to the imminent risk of sudden death ; yet, by a
very careful and quiet life, and by thus inducing a slow
and moderate action of the heart, the fatal day may be
long averted.

I well remember, some years ago, watching, w'ith
painful interest, a poor man in the University College
Hospital, in whom an aneurism of the arch had, by
absorption, penetrated through the sternum and ribs.

TREATMENT.

103

and pulsated as a shining red tumor,, with walls apparently
as thin as parchment.

The hourly death of this poor man was looked for,
but he lived for months under the above circumstances,
and had lived for three years since the first manifesta-
tion of the disease. I omitted to ascertain the manner
of this man’s death, but I believe it was not by
external rupture.

TREATMENT.

The Treatment of aneurisms of the thoracic aorta can
be only palliative.

Valsalva recommended full and repeated bloodlettings,
with starvation ; but, although modern medicine has
abandoned, this method as one from which humanity
revolts; and as, in a scientific point of view, useless
or worse, yet leechings and occasional bloodlettings
are still sometimes recommended. But, surely, the
practice of a strict diet and regimen must be infinitely
superior to that bloodletting, which is so apt to produce
anaemic or nervous palpitations of the heart, besides
being inimical to the formation of those fibrinous
deposits, by which process mainly can the final rupture
of the aneurism be delayed.

The same objections, I think, hold good against the
exhibition of those purgatives and diuretics which are
also recommended. The treatment of this disease will
be much the same as that for dilatation of the heart,
viz., great carefulness of life — an abstemious diet,
with regular but very quiet exercise, consisting in
either slow walking, or very gentle carriage exercise.

A gutta-percha compress might be worn over

104

THE HEART.

excentric aneurism, and gentle, yet firm, pressure from
the hand of a friend, will, at all times, afford a sensa-
tion of pleasing support.

The stomach must he attended to, and all forcing at
stool must he avoided.

Aconite, Bryonia, Nux Vomica, and Lachesis, are-
the four homoeopathic medicines which will he most
frequently employed.

Dr. Stokes, writing on the treatment of aneurism,
most truly observes (p. 590) : “ It often happens that
a patient who has not been interfered with, will con-
tinue with unimpaired health and strength for a great
length of time, until he is so unfortunate as to he
placed under treatment for the cure of his aneurism.
Then the evils which have been pointed out as occurring
in cases of indolent diseases of the heart, when injured
by ignorant treatment, are induced. The patient's
mind becomes excited and apprehensive. His system
is weakened by depletion, and his digestive functions
ruined by starvation. The forces by which he can
resist disease are broken down, his blood becomes un-
coagulable, his tissues unresisting ; and the disease,
which might have endured for years, is turned into
a rapid and destructive malady." Again : “ It is too
evident that, as the lesion cannot be cured, the system
should not be tampered with." In these observations,
equally, as in very many others which continually
occur in the writings of Dr. Stokes, the liomoeopathist
must fully agree ; and ardently hope that an equal
measure of philosophy with regard to the treatment of
all other diseases, m ay, at no distant day, animate uni-
versally the old school of medicine.

105

ABDOMINAL ANEURISM.

Aneurism of the abdominal Aorta does not come to
be considered in treating of diseases of tlie cliest,
further than that, by pressure on the diaphragm, it
may influence the position of the heart and lungs, and
may yield also a percussion dullness in the thorax.

Abdominal aneurism may increase to a great size
before attracting attention ; as, from the yielding nature
of the abdominal organs, little constitutional or sensa-
tional symptoms may appear. But the lumbar vertebrae
may become more or less absorbed from pressure,
and intense pains be the result.

Much erosion, however, has sometimes taken place in
the lumbar vertebrae, and yet the patient has suffered
so little inconvenience, as to be able to ride on horse-
back and take delight in the hunting field. Dr.
Stokes gives the history of a case of this kind. Again,
the severe pains produced by pressure may sometimes
be relieved by the patient altering his position, as by
his resting on his hands and knees.

Death is said to result from abdominal aneurism,
in an average of from six months to three years.

The Diagnosis will consist in distinguishing it from
water in the kidney or enlarged kidney, cancer or
tubercle of the mesenteric glands, fibrous tumor,
enlarged vertebrae, lumber abscess, or hard accumula-
tions of faeces — all of which have simulated aneurism, and
all produced pulsations synchronous with the heart’s
action. Also from pulsating aorta, and from the flutter-
ing actions common in nervous dyspepsia or hysteria.
Hard accumulation of faeces can usually be distin-
guished by its knotty form and putty-like consistence ;

106

THE HEART.

yet I remember seeing a case, where one of the most
acute hospital physicians of the day, after long and
laborious examination, diagnosed “ pulsating abdominal
aneurism” — while the post-mortem examination, which
followed after a few days, revealed only an accumulation
of hard faeces.

One assistance to the diagnosis of this disease lies in
the fact that it seldom, if ever, produces ascites, or
even puffiness about the ankles, as occurs from malig-
nant tumors. Those friction sounds, the result of
inflammatory or fibrinous exudation, connected with
the viscera, are also wanting.

It may be remarked, that tumors in the neighbour-
hood of large arteries, if the vessel be thereby irritated,
will often call forth strong pulsations in the offended
artery ; and it is here, probably, that an explanation of
false diagnosis may sometimes be accounted for.

The obstinate perseverance of lumbar pains, not to
be explained by the condition of the kidneys, the pre-
sence of piles, or the condition of the uterus, may
justify the suspicion of abdominal aneurism.

RECAPITULATION.

With regard to chronic diseases of the heart, it may
not be unuseful briefly to remind the physician, and
to assure the patient —

1. That sudden death is the exception, not the rule,
in heart disease.

2. That as, in habitual dyspeptics, by the careful
regimen of the patient, life is usually prolonged beyond
the period enjoyed by fast-living, strong men; so in
many diseases of the heart, by proper treatment and

RECAPITULATION.

107

regulations, a fair average duration of life may be
attained.

3. That loud organic murmurs are often indicative of
a smaller amount of danger than excessive weakness of
heart, although the former is generally regarded with
extreme apprehension, while the latter may often be
comparatively disregarded.

4. All irregularity or violence of mental and bodily
action, and all severe medical treatment, are alike inju-
rious in diseases of the heart.

THE LUNGS AND THEIR FUNCTIONS.

The form of the cliest containing the lungs and heart
may be regarded as a somewhat flattened cone. The
lungs and heart fill this chest accurately The lungs
are suspended by the trachea and bronchi, and by the
arterial and venous trunks which proceed to and from
the right side of the heart, and they rest on the dia-
phragm.

The right lung is divided into three lobes, the left
lung has only two ; the position occupied by the heart
to some extent occupying the space of the absent third
lobe.

The chest is lined with the pleura, a serous mem-
brane, which covers also the entire free surface of the
lungs and the surface of the pericardium. The pleurse,
being smooth and moist, admit of the soft gliding of the
organs over each other.

If the lungs weigh forty ounces, the right will weigh
about twenty-two and the left eighteen. The lungs of
the male are not only actually but relatively larger than
those of the female. This may be partly because the
female chest is often more compressed than that of the
male ; but I believe the female has naturally less lung
action ; and that, on the other hand, her liver will be
found to be relatively larger than that of the male (see
my paper on the “ Liver, the Hydrogenitor in Animals,”
London Journal of Medicine, 1851).

The substance of the lungs is composed of the

THE LUNGS AND THEIR FUNCTION.

109

innumerable subdivisions of the bronchi and of the
pulmonary artery and vein, together with its own air-
cells and intermixed cellular tissue.

The bronchia divide and subdivide, but do not anas-
tomose. Rings of involuntary muscular tissue surround
the bronchi and bronchia, contracting and dilating
with the expiration and inspiration of the lungs, but
this muscular tissue does not exist in the ultimate
bronchia. The larger are kept open by cartilaginous
rings ; these rings break up, as it were, becoming fewer
and fewer as the tubes diminish in size ; and when the
bronchia become very minute, no cartilages exist. The
ultimate divisions of the bronchia are about the 3V of an
inch in diameter, and are surrounded by, and terminate
in clusters of the true air-cells of the lungs.

The air cells are, like the ultimate bronchia, lined
with squamous epithelium, and supported by fibres of
elastic tissue ; they are from the to 27^ of an inch in
diameter ; but in asthma and often in old age they are
much larger. They are composed of very fine thin mem-
brane, closely covered over by a net-work of capilla-
ries, viz., from the subdivision of the pulmonary artery
and vein. These air-cells, if spread over a surface,
would occupy a space about the extent of the floor of
a moderate-sized room, viz., about twelve feet square,
and must be about one hundred millions in number.

The bronchia are nourished by arteries of their own,
which also secrete the mucus of the bronchial tubes.

The lungs are also furnished with lymphatic vessels
and glands, especially in connection with the large
bronchia, which glands are prone to become the seat of
calcareous and carbonaceous deposits.

The nerves of the lungs are from the anterior and

110

THE LUNGS AND THEIR FUNCTION.

posterior pulmonary plexuses of the pneumogastric,
joined by others from the sympathetic and fine nerves,
follow the air tubes as far as the air-cells.

At birth, the lungs are of a fine light pink colour ; but,
as age advances, they become of a dark grey, from the
deposit of carbon in the intercellular tissue. The grand
function of the lungs is to bring the venous blood into
contact with the atmospheric air. When this is done,
the purple blood sent to the air cells from the right
side of the heart by the pulmonary artery, is immediately
converted into bright red blood, which returns by the
pulmonary vein to the left side of the heart, and is from
thence sent all over the body.

Atmospheric air is composed virtually of seventy-nine
parts nitrogen and twenty-one parts oxygen, by measure.
When this is breathed, it will be found that a certain
amount of oxygen disappears, and a certain amount of
carbonic acid gas is expired in its place.

It would appear, from quantitative calculations, that
the province of the oxygen chemically is more to take
up the effete carbon presented to it by the venous blood
of the lungs, than itself to unite with other compounds,
and pass into the circulation. Still oxygen must act posi-
tively on the iron, that is, on the red globules, in the
blood ; and it is impossible not to believe that it has,
beyond its depurating effect, by its action on effete carbon
also a positive and vital action on the arterial blood itself.

It is generally believed that the nitrogen of the air
has only the negative property of diluting the oxygen ;
and this is the more believed, as frequently there is no
diminution in the amount of nitrogen in expired air ;
but sometimes there is a diminution ; and, for myself,
I cannot believe in the merely negative action of so

THE LUNGS AND TIIEIR FUNCTION.

Ill

important an element as tlie nitrogen in the air we
breathe.

By an ordinary respiration, the lungs take in about
twenty cubic inches of air. In easy breathing, we
inspire and expire about fifteen times in a minute ; in
disease and in hysteria the respiration may fall to eight
in a minute, and may be as many as eighty in a minute.
TVe therefore inhale 300 cubic inches of air in a
minute, or about 432,000 cubic inches a day ; that is,
about 1500 gallons of air in twenty-four hours.

About sixteen ounces of watery fluid are given out by
the lungs in twenty- four hours.

In the respiration of an ordinary individual, about

40.000 cubic inches of oxygen disappear; and a like
quantity of carbonic acid gas is thrown out in twenty-four
hours ; that is, about nine ounces of solid carbon is
expired by each individual daily.

Atmospheric air contains only about 3 parts in

10.000 of carbonic acid gas ; and as the presence of a
very small increase of this gas in the air of a chamber
is sufficient to render that room unwholesome, and as
an individual expires about a cubic foot of carbonic acid
gas in an hour, it follows that, without sufficient venti-
lation, an ordinary sized chamber must very soon be-
come an unwholesome and even a dangerous residence.

Pure air is the very life of the blood, and more dis-
ease is induced by bad air than by any other known
cause ; and, as I pointed out in a paper on the “ Ventila-
tion of Dwellings,” in the f Transactions of the Social
Science Association/ vol. 1857, it is quite as much the
duty of the State to see that buildings are properly
constructed in reference to ventilation, as to compel
builders to construct water-closets and house-drains.

112

THE LUNGS AND THEIR FUNCTIONS.

The heat of the body, that is, the heat of the blood,
is from 96° to 98°. It is only one degree higher in the
tropics than in temperate climates. In cyanosis it has
been known as low as 78°, and in fevers as high as 105°.
It is believed that the heat of the blood is caused by
the chemical union of the oxygen of the air with the
carbon and iron of the blood.

There can be no doubt that heat is evolved under
this chemical action ; but every action in the body, and
every mechanical, chemical, vital, and mental change
must be productive of a change in the temperature of
the living body. Dr. Wilkinson pithily observes, “ Take
the soul out of the body, and you may indeed roast it or
boil it, but you cannot warm it with one ray of animal
heat”

The air expelled from the lungs is usually more or
less hot. It is hotter in the young and vigorous, and
in fever, than in the old or lethargic, and may be nearly
cold in cyanosis, and quite cold in cholera. In health
the breath should be odourless ; but as it contains am-
moniacal excretions, it becomes putrid if retained, and
hence adds to the offensive odour of a bed-room ill
ventilated.

In saccharine diabetes, the breath has a mawkish,
sweet odour. In other kidney disease it may be urinous.
In phthisis it has a sickly odour ; and in dyspepsia it is
sour or foetid.

Physiologists teach that the act of inspiration is caused
by the depression of the diaphragm, and by the muscles
of the thorax elevating the walls of the chest, by which
a vacuum is caused, which the air rushes in to supply ;
and that expiration is caused by the collapsing again of
the walls of the chest, and the elevation of the dia-

THE LUNGS AND THEIR FUNCTIONS.

113

phragm, whereby the air is expelled from the chest;
which last act, it is admitted, is aided by the contraction
of the muscular tissue of the bronchia.

I confess that it appears to me that this explanation
is quite fallacious, and I believe that the entire acts of
inspiration and expiration are caused by the lungs
themselves.

It is admitted that the act of expiration is partly
caused by the contraction of the muscular tissue of the
bronchia. Now that tissue is an involuntary muscular
tissue, and the act of respiration proceeds day and
night as regularly as the actions of the heart.

When the muscular tissue of the bronchia contracts,
the air contained in the bronchia must be expelled ; and
when that tissue is relaxed, or, more properly speaking,
when it becomes dilated, there must occur a vacuum,
and the air must, by an absolute necessity, rush in to
supply that vacuum.

If any one will watch the action of respiration in his
own person he may convince himself that the muscles
of the thorax are not those which cause the expansion
and contraction during inspiration and expiration, but
that the walls of the chest rise and fall entirely owing
to the internal forces operative in the lungs themselves ;
and it is only in forced inspiration, when the individual
forces up his shoulders and endeavours to expand his
chest, that the muscles of the thorax supplement the
action of those of the lungs.

In treating of the circulation of the blood, I endea-
voured to show the fallacy of the doctrine that the con-
tractive power of the left ventricle is sufficient to com-
plete the circulation, without the aid of the suction
power of the heart ; and it appears to me to be as sin-

114

THE LUNGS.

gular a fallacy to suppose tliat tlie lungs themselves
have not sufficient power to carry on their own special
function, viz., to aerate the blood by their incessant
action, day and night, of alternately expanding and
contracting.

When we consider the extraordinary refinement of
texture, tlie thinness of the cell-walls, the broad expo-
sure of the capillary system, and the wonderful func-
tional powers of the lungs, we cannot be surprised that
in a changeable climate like that of Great Britain,
diseases of these organs should be so frequent and so
fatal. On the other hand, how much must we not
admire that wonderful conservative power of nature,
which can enable the masses, especially in our great
manufacturing towns, to enjoy a tolerable measure of
health, surrounded as they generally are by, and breath-
ing as they do — that is, subjecting the brain and blood
to the influence of— so much that is impure and con-
trary to man’s mental and bodily welfare.

THE PHYSICAL EXAMINATION OF THE LUNGS IN
HEALTH AND DISEASE.

By the term piny steal examination of the lungs, is
meant that examination of the chest by the hand, the
eye, and the ear, by which the physician is enabled to
ascertain the physical condition of the lungs in health
and disease.

From the days of Hippocrates downwards, physicians
had a certain amount of loose knowledge of both aus-
cultation and percussion. They knew, for instance,
that tympanitic percussion sound over the abdomen in-
dicated flatulence, and that fractured bones, on being

PHYSICAL EXAMINATION.

115

moved, furnished crepitation. They were also in the
habit of feeling and listening to the force of the heart’s
action ; and Hippocrates mentions that " a sound re-
sembling boiling vinegar could be heard if the chest
contained water,” — probably the bubbling crepitation
of bronchitis. But since the works of Avenbrugger and
Laennec were first published, the art of auscultation
and percussion has become more exact, and to these
men, physicians of the present day arc almost
entirely indebted for all that is valuable in the art
itself.

Percussion ( percutio , to strike), as a means of diag-
nosis in diseases of the chest, was first systematised by
Dr. Avenbrugger, and given to Vienna, after eight
years’ labour, in 1761. It was, however, neglected by
physicians until introduced into Paris, by Corvisart, in
1808.

Auscultation ( ausculto , to listen,) was first systema-
tised by Dr. Laennec, and given to the medical world
of Paris in the year 1815. This celebrated man, whose
work is the basis of almost all works on diseases of the
chest which have since appeared, was born in 1781, and
died in 1816, of consumption.

By auscultation and percussion, the physical condi-
tion of the lungs and heart can generally be ascertained
with the utmost exactness, and thus, in many ambigu-
ous cases, not only is the aid thus obtained as a guide
to right medical treatment most important, but know-
ledge is often obtained, which, leading to the altered
conduct and circumstances of the individual concerned,
may be of more value than even life itself.

The general symptoms of a disease must generally
be of more value than the physical signs, and yet,

116

THE LUNGS.

without a knowledge of auscultation and percus-
sion, symptoms may, and often do, mislead into fatal
error.

For instance, all physicians must have met with cases
where medical men, mistaking organic palpitations of
the heart for mere nervous affection, have recommended
wine, beef-steaks, and vigorous exercise, to the immi-
nent risk of the patient’s life. Again, in many cases,
long-continued cough, with expectoration, and, it may
he, wasting and hectic, has been set down as consump-
tion, and the patient banished to a foreign land, while
all the time not a trace of tubercle existed in the
lungs.

On the other hand, there is certainly a danger of
falling into one-sidedness and pedantry on the part of
those whose minds, dwelling it may be, too exclusively
on physical signs and pathological anatomy, are apt
not only to under-estimate the value of general symp-
toms, and the constitution and individuality of the
patient, but the value of medical treatment altogether.

Were the science of medicine as exact and certain
as that of auscultation, it would, indeed, be an easy
thing to heal all manner of diseases. But, inasmuch
as most diseases are either directly or indirectly brought
upon man by his evil deeds, it would be but a doubtful
boon to humanity, were the science of healing, from
without, to become absolute and unconditional.

The principles involved in auscultation and percus-
sion are purely mechanical.

Percussion over confined air, as over the intestines,
will yield the most aeriform or elastic sound, percus-
sion over confined water, as over the bladder, will
yield the densist sound ; and so percussion, over good

INSPECTION OF THE CHEST.

117

lungs, will yield a clear sound — tliat over consolidated
lungs, will yield a dull sound.

So also the heart and lungs, when healthy, yield to
auscultation certain pure sounds ; but, when these organs
become the seat of disease, the sounds are either ab-
normally weak or loud — impure, muffled or coarse, &c.

In order to afford facilities of description, the chest
has been divided into certain somewhat arbitrary
regions, for a delineation of which, and the normal
position of the contained organs, I refer the reader to
the diagram and description at the beginning of this
volume.

INSPECTION OF THE CHEST.

Although Laennec was inclined to regard the facts
gathered from inspecting the chest as of little value,
yet more recent writers on physical diagnosis regard
the operation of inspection as of considerable value.
AY hen an individual desires a thorough examination of
the chest, it is certainly advisable that an inspection
should be made of the figure nude to the waist,
because, although auscultation and percussion can be
performed often with sufficient accuracy through a
flannel or a cotton shirt, yet, when minute differences
in the form and moving power at different parts of the
chest require to be ascertained, this can only be done
with exactness when the naked thorax is exposed.
There are, however, many cases -which do not call for
so minute an inspection.

Inspection. — The patient being quietly seated, we
ascertain whether the chest is large or small, fully
developed or contracted, symmetrical on both sides,
or otherwise. Whether the body is emaciated or not,

118

THE LUNGS.

and whether there exist any local bulgings or depres-
sions of a suspicious characters ; also, whether the chest
expand freely and symmetrically on full inspiration;
and lastly, information is to be obtained from the
colour, texture, and condition of the skin.

The perfectly formed chest is rarely seen among
civilised nations, except in marble, the controlling
influences of dress, occupation, or habits, causing more
or less deviation from perfect symmetry. But in
relation to actual disease, beyond such violent distor-
tions as result from the scrofulous deformities of the
spine, sternum, or ribs, what has chiefly to be
observed is the presence or absence of abnormal local
bulgings or local depressions.

Bulgings may arise from fatty deposit, from abnormal
muscular development, from fibrous, cancerous or tuber-
cular tumours, from abscesses in the mediastinum,
or elsewhere, from enlargement of the heart, spleen,
or liver, from fluid in the pericardium, or in the pleural
cavities, from emphysema of the skin or of the lungs,
from air in the pleural cavity, or from aneurism of the
aorta, &c.

Depression may be local or general. In excessively
thin individuals there is usually much depression below
the clavicles, or, if the clavicles are more than usually
arched, the depressions are often very deep. The mil
habit of stooping may carry general depression of the
chest to the extent of deformity. One lung may be
compressed by pneumothorax, or pleuritic effusion may
cause it to be bound down by fibrous bands, or cause
local contractions — pneumonia may render the lung
in part permanently impervious to air, in which case
there will be a corresponding depression — pressure

INSPECTION OF THE CIIEST.

119

on a main bronchus, by diminishing or preventing the
entrance of air, -will be followed by depression.
Cancerous deposit will cause contractions and depres-
sions ; but the great pathological cause of local depres-
sion is the presence of tubercle in the lungs, and
that especially in the sub-clavicular regions. If one
lung be much depressed the chest-walls, by falling in,
must more or less distort the spinal column and the
sternum, and also the clavicle, the shoulder, and the
ribs of the healthy side.

The amount of general expansion of the chest, on full
inspiration, is no infallible test of the presence or absence
of disease. An individual of a nervous, sanguine, or
energetic temperament, will generally be able to expand
his lungs much more than an individual of a lymphatic
temperament, and yet, in the first case, there may
be tubercles in the lungs, and none in the second
instance.

Many individuals appear scarcely capable of expand-
ing their chests, while others have great power. The
average difference of circular measurement between
full inspiration and full expiration, is about one and
a half inches ; but some can expand their chest to three
or four inches above the minimum measurement.

In calm breathing the movements of the diaphragm,
and consequently of the abdomen, are more marked
than those of the upper part of the chest, but this
observation refers to males more than to females, in
whom the thoracic breathing is, under all circum-
stances, more marked, the “ heaving of the female
bosom ” being a proverbial expression. The reason for
this difference is not fully explained on any mechanical
principles. This, at least, is certain, that the lower

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TIIE LUNGS.

part of the female cliest is often confined by stays, while
tlie ribs and sternum of man arc stronger, and therefore
more unyieldingly fixed than those of woman. Still the
difference exists to some extent between male and
female children who have never worn stays. Further,
according to Boerliaave and Haller, nature may have
made some provision against abdominal breathing in
women, as the existence of pregnancy would be too con-
siderable a hindrance to its freedom.

In forced breathing the chest-movements in the
male and female are much alike in mechanism; the
chest-movements in both much predominating over the
abdominal.

The expansion of the chest will be interfered with,
if there be any pleuritic or intercostal pain of an
inflammatory or neuralgic origin, checking full inspira-
tion, and in such cases, the respiration will be chiefly
abdominal. Or, if the lung be inelastic, from the
effects of former pleurisy, pneumonia, or foreign
deposit; or, if the bronchial passages be impeded by
mechanical or by spasmodic stricture.

On the other hand, in hysteria, or in the forced
inspiration of the asthmatic, the expansile heaving may
be very great.

In calm normal breathing, if we assume for the sake
of illustration, that the entire act occupies a period
equal to eleven, then inspiration will occupy a period
equal to about six, the turning point one, and expira-
tion four.

But this rhythm is altered in different diseases ; in
asthma the inspiration is much prolonged, and in
emphysema the expiration is impeded and prolonged.

If any cause impede the free respiration of one

TIIE APPLICATION OF TIIE HAND.

121

lung tlie movement of tlie other lung will most likely
be exaggerated.

In the event of pleuritic or intercostal pains the
breathing will be chiefly abdominal ; on the other hand,
when pains exist in the diaphragm or intestines the
breathing will be chiefly confined to the upper part of
the chest.

THE APPLICATION OF THE HAND.

By the application of the hand to the walls of
the chest — or rather by gently yet firmly applying
the pulpy ends of the fingers — the expansile power,
as distinct from the mere elevating power of the
subjacent lung, may be in a measure judged of.
Also when the individual experimented on speaks, what
is called the vocal vibration or fremitus is perceived. In
dry pleuritic effusion, what is called friction fremitus,
accompanies the movements of respiration, from the
rough surface of the costal and pulmonary pleura
rubbing over each other.

The intensity of vocal vibration will be in propor-
tion to the firmness, graveness, and force of the voice,
existing but little in children or in voices of a high
pitch. It is felt much more strongly in the thin than
in those thickly clothed with muscular tissue or fat, and
is often not to be found at all. Vocal fremitus being
caused by the vibration of the bronchial tubes, it follows
that it is most prominent over the upper and middle
part of the chest, in the region of the main bronchi.

Enlargement of a bronchus will yield an increase of
vibration over the seat of the enlargement, and any
tumor communicating with a bronchus and thus

122

THE LUNGS.

bringing that bronchus virtually to the surface, will be
followed by abnormally increased vibration. Hence
also tubercular, cancerous, or pneumonic consolidation
furnish abnormally developed vibrations. But the amount
of cancerous or other consolidation may be so great as
to fail to respond to the vibrations of the bronchus com-
municating with it. If the lungs be separated partially
or entirely from the chest walls by water or air the
vibration is weakened or destroyed.

The right bronchus being larger than the left, is
accompanied by proportionately stronger vibration.

Bronchitic rhonchi may cause vibrations of the
bronchi, extending to the walls of the chest.

MENSURATION OF THE CHEST.

Mensuration of the chest by means of callipers or a
tape is a method a good deal employed by some physi-
cians, in order to ascertain the amount of expansile
power and the different size of each side of the
chest.

It has always appeared to me that the educated eye
and hand are, however, not only better means of
judging, but that they are actually much more exact
means of measuring the normal and abnormal develop-
ments of the chest, while the general play of the
chest can be judged of by the eye much better than by
any other instrument. By a tape the difference of the
circumference of a chest, after full expiration and full
inspiration, can be easily measured, but this measure-
ment will afford no certain evidence of the condition of
the lungs, the expansile power of which will often

MENSURATION OF THE CHEST.

123

depend on the flexible condition of the ribs and muscles,
and especially on the energy of the individual. The
bulgings from tumors, emphysema, aneurisms, &c., are
much easier to measure by the eye and hand than
by tape, and, in short, he who practises the e}re and
hand, and relies upon tact, penetration, and judgment,
can, with much profit, dispense with many minute con-
trivances offered in aid of diagnosis.

To the eye, the right side of the chest, in right-
handed men especially, is larger than the left. The right
lung is itself somewhat larger than the left, and the
right bronchus is therefore also larger than the left,
and thus the respiratory movements are on the right
side somewhat greater than on the left side.

The spirometer is an instrument invented by Dr.
Hutchinson, which measures the number of cubic
inches of air which, after a full inspiration, an indivi-
dual can expire without drawing extra breath.

Like the power of expanding the chest, the amount
of air expired will depend, of course, on the size of the
individual, and of his chest ; but it will also depend
more on the energy, determination, and endurance of
the individual. The instrument cannot, therefore, be
regarded as any trustworthy means of measuring the
amount of pulmonary disease, and, of course, has no
power of indicating the nature of that disease which
may be present.

By the daily practice of full inspiration and expi-
ration, together with the practice of such gymnastic
exercises as expand the chest, any individual whose
lungs are not actually diseased, may increase his respi-
ratory powers, on the same principle that he may
increase the size and power of his arms by the use of

124

THE LUNGS.

arm-gymnastics. Such gymnastic exercises as expand
the chest walls, especially if accompanied by the daily
periodical practice of full inspiration and expiration,
habitually followed night and morning for years, must,
as an exercise for the lungs, be a preventive of debilita-
ting, and, I believe, to a considerable extent, of tuber-
cular disease. Reading aloud, free and bold declama-
tion, and singing, and loud laughter, must also be very
salutary practices. The practice ladies have of walking
with the arms crossed must tend to contract the chest,
while the free swinging of the arms must expand the
chest.

The round backs and hollow chests of the indolent,
the weak, and the sedentary, must naturally interfere
with the free oxydation of the blood ; and so also I
believe do, not only tight cravats, but the modern prac-
tice of the male throat being covered by shirt collars,
cravats, and coat collars.

A cricketer, or any man wishing freedom of action or
ease, if not under the constraint of society, removes his
shirt collar and cravat, and surely that which is free
and comfortable must be in relation to health that
which is good and right. It has always appeared to
me that the cravat and collar question was one which
demanded more consideration than it has received either
from the public or the physician. Many men have told
me that they had become less liable to sore throat the
less they over-clotlied their throats, and why the tender
female should have a free throat while the muscular
man has his throat incased in coat collars, shirt collars,
and cravats, common sense and physiological laws
would find some difficulty in answering.

Freedom of respiration is, in health, aided by exer-

PERCUSSION.

125

rises, especially sweating exercises ; and in many dis-
eases by sweating, viz., skin expiration, produced artifi-
cially, as by tlie liot-air bath.

PERCUSSION.

By percussion , a knowledge of the elasticity, or reso-
nance, or the reverse of the subjacent tissue, is to be
obtained.

This resonance is in direct relation to the aeriform
nature of the organ percussed.

If the bowels inflated with air be percussed, the sound
elicited is tympanitic. If the healthy lungs be per-
cussed, the sound elicited is sonorous and clear ; if the
region over the heart be percussed, the sound elicited is
dull and solid; if the chest filled with water be per-
cussed, the sound obtained is a dead sound.

And thus, if we percuss over tubercular or other de-
posit, sounds, more or less dull, are obtained in direct
relation, cceteris paribus, to the solidity and bulk of the
deposit.

Percussion of the chest may be performed either im-
mediately or mediately.

Immediate percussion is performed by striking the
surface of the chest with the tips of the fingers, and
Avenbrugger followed this method.

Mediate percussion, introduced by M. Piorry, is, how-
ever, now almost exclusively employed ; first, because
the shock and pain are less to the patient ; second, be-
cause we can strike with more precision, and reach the
part percussed more intimately.

Some physicians, especially on the Continent, employ
a piece of ivory, called a pleximeter (a foolish word, lite-

126

THE LUNGS.

rally a measurer of percussion), as a medium on which
to strike, and as a striker employ a little hammer with
a vulcanised india-rubber point; but all extra instru-
ments used in manipulatory medicine, if not necessary,
must be worse than useless, tending, as they do, to
weaken general precision and expertness, — the good
workman being known not by the number of his tools,
but by the good use he makes of those he has.

For percussion, no tools are equal to the fingers of
the right and left hands.

The middle finger of the left hand is the best medium
to strike on, and should be placed closely and firmly on
the place to be percussed.

As a striker, the first two or three fingers of the right
hand should be held closely together, with the tips on
the same plane ; and more freedom of striking is ob-
tained, I think, if the thumb and little finger be kept
loosely apart.

For percussion, I repeat, no instruments are equal to
the human hands ; for by them not only can the sounds
be elicited most naturally, but by the intimate handling
of the patient truer and closer knowledge is obtained
than that to be felt second-hand, through pieces of
wood or ivory.

Light and localised percussion, by the middle finger
of the right hand only, may be useful in eliciting slight
superficial sounds ; and, on the other hand, when broad
general percussion-sounds only are wanted, it may be
sufficient to place the palmer surface of the left hand
on the chest, and to palpate with the palmer surfaces of
the fingers of the right hand.

In percussing, the blow should be given from the
wrist, and not from the elbow or the shoulder ; and,

PERCUSSION.

127

simple as the process may appear, yet dexterity and
precision in this, as in all other manipulations, is an art
only to be obtained by practice, and is by many appa-
rently unattainable.

By gentle percussion, the superficial condition of the
lungs may be obtained ; by strong percussion is to be
obtained the more deeply-seated conditions. Both light
and strong percussion are generally advisable in the
same case. If the individual percussed be very fat or
very muscular, gentle percussion will not generally elicit
anv useful information : and indeed, if the individual
be exceedingly fat or muscular, even strong percussion
has often considerable difficulty in eliciting the infor-
mation required.

The patient, when under examination by percussion,
should, unless confined to bed, sit on a chair. "When
the front of the chest is being examined the arms
should be drawn slightly back, so as to relieve the chest
of flabbiness ; and when the back is being percussed,
the patient, by slightly stooping forwards, renders the
back smooth. The patient must sit with the shoulders
on the same level, otherwise an appearance of want of
symmetry is given to the chest; and if the muscles
over one part be in a state of greater tension than over
another, a slight modification of percussion-sound will
be produced.

When it is necessary to compare the percussion -sound
of one side minutely with that of the other side, the
operator must be sure that he percusses not only with
equal force, and in the same corresponding place, but
with the pleximeter finger applied at the same angle ;
for instance, he should not lay the finger across the ribs
at one part, and parallel with the ribs on the other.

128

THE LUNGS.

There is one other observation which it is necessary
to make, viz., that in acute disease, where there is
debility, it is important to remember that no further
percussion should he used than is necessary. I am
much inclined to believe that I have often seen serious
mischief result to the patient from over-percussion by
the physicians and pupils at our public hospitals.

The texture of the true substance of the lungs is the
same throughout ; hut percussion yields very different
sounds, according to the region percussed.

Such portions of the lungs as are in juxta- position
with the heart, liver, diaphragm, spleen, and with the
stomach when filled with food, will yield a sound
modified by the proximity of such solid parts. Percus-
sion also over the chest, for instance below the clavicles,
will be very clear, as compared with percussion through
the thick muscles over the supra-scapular regions,
or over the spinal regions. Percussion, again, in the
region of the large bronchi, or near the stomach, when
filled with air, will yield sounds proportionally clear.

In the diagram at the beginning of this hook, the
reader will observe the relative position and extent
of surface presented by the different organs, and he
able to judge better than by written descriptions of their
modifying influences.

When the lungs overlap solid organs, light percus-
sion will yield clear sounds, while strong percussion
will yield sounds modified by the subjacent solid organ,
e. g., as over the heart and the liver.

The extra thickness of the right pectoral muscle,
in muscular right-handed men, will cause an increase
of dulness in the percussion- sound of that region.

Pull inspiration will increase the amount and extent

PERCUSSION.

129

of clearness on percussion. First, by increasing in
the lungs the proportion of air in relation to the solids ;
second, by depressing the diaphragm and liver, and
overlapping the heart by the expansion of the lungs ;
and therefore, in percussing, where much minuteness
is necessary, both sides must be tested when, as much
as possible, the same amount of air is present in
the lungs. This is most readily secured after a full
inspiration, when the patient should be directed to
hold his breath until the percussion-sounds of both
sides are compared.

Percussion-sounds are clear, cceteris paribus , in pro-
portion to the youthfulness and thinness of the patient,
but unusual clearness or unusual dulness is often
met with in healthy subjects, it being often difficult
to give a satisfactory reason for the difference. It
may sometimes be, that the cellular tissue predominates
naturally over the vascular, and, in other cases, the
vascular over the cellular. If so, the first will yield
abnormally clear sounds; the second abnormally dull
sounds. This is a suggestion which I throw out,
and which seems to have some confirmation, from the
fact of the vascular system increasing with age, while
clearness of resonance is usually in the direct ratio of
youthfulness.

The more solid the organ percussed, the greater is the
^sense of resistance on percussion ; hence, clear percus-
sion sound obtained by percussing gently over a tumor,
which communicates with a large bronchus, although,
perhaps, tympanitic in sound, will be resistant in sensa-
tion.

Abnormal dulness on percussion may arise from the

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THE LUNGS.

following causes : — Tubercular, cancerous, or fibri-
nous deposit or tumors — congestion, pneumonic in-
duration, serous infiltration, or chronic consolidation
— abscess, gangrene, hydrothorax, hsemothorax, pleu-
ritic effusion, empyema, muco-purulent accumula-
tions in the bronchi, enlargement of the heart,
aneurism, enlarged bronchial glands, and also from
any other mechanical or spasmodic cause, hindering the
full inflation of the lungs.

Abnormal clearness on percussion, under the name of
tubular, amphoric or large tubular, or tympanitic per-
cussion, may arise from pneumothorax, emphysema,
a dry cavity filled with air, dilated bronchi; and,
possibly, when owing to pleuretic effusion occupying
the lower part of the lung the upper part is, in com-
pensation, more fully inflated ; also in one lung, in
compensation, if the other lung has been temporarily
or permanently rendered incompetent, or, if tumors or
solid deposit communicating with a large bronchus, bring
that as it were to the surface of the chest.

One form of hollow percussion sound has been called
the “cracked metal” sound. It resembles the sound
produced when the clasped hands are struck on the
knee, whereby the air contained between the palms is
suddenly expelled.

In the lungs, this sound is produced when the air by
percussion is driven suddenly out of a cavity.

Dr. Walshe has shown that it is not produced if the
mouth and nose of the patient be closed during the
percussion.

A sound analogous to it is sometimes produced,
especially in children having bronchitis, probably,

AUSCULTATION.

131

because from the elasticity of their chest-walls, the
incarcerated air of the larger bronchi is, by percussion,
readily and rapidly driven out.

If the dull percussion sound arise from the presence
of fluid, the region of dulness may often be altered, on
the patient assuming another position, the fluid gravi-
tating accordingly ; but the fluid may be so great, that
no alteration can take place in its position, or it may be
incarcerated locally by pleuritic adhesions. If tumors
be moveable — a rare occurrence in thoracic tumors —
the position of the dulness will also be moveable.

If tubercle be thinly scattered say over the upper
part of a lung, full inspiration by expanding the lung
will theoretically separate the tubercles, and yield per-
cussion sounds less dull than after full expiration, when
the tubercles are more closely packed ; but as full in-
spiration itself, independent of the presence of tubercles,
causes increased clearness on percussion, the value of
this test must be difficult to define.

Emphysema should be more easily detected on full
expiration, the emphysematous condition being thereby,
as it were, exaggerated in relation to the other parts of
the lung.

AUSCULTATION.

Auscultation (ava-KvXroj, to listen), with reference
to the chest, is the act of listening to the sounds pro-
duced by the action of the heart and lungs in health
and disease.

Auscultation may be performed immediately by ap-
plying the ear to the chest, or mediately by the use of
the stethoscope (cmOog, the chest; <x/co7TEtt>, to examine).

By immediate auscultation it appears to me that the

132

THE LUNGS.

natural sounds of the chest are heard not only easier,
but with more truthfulness, as they come direct to the
ear, and are not modified in character by the interpo-
sition of a piece of inanimate wood. But as in auscul-
tation it is often necessary to ascertain the minute
differences existing often in circumscribed parts which
the unassisted ear has difficulty in reaching — as at the
region immediately below the clavicles — it is only by
the stethoscope that this can be done with exactness ;
further, it must sometimes be inconvenient or unplea-
sant to both parties to apply the naked ear to the
chest.

The stethoscope should be a hollow cylinder of wood,
from five to seven inches long, with one end made to
fit the ear closely and comfortably, the other end made
to rest on the chest closely and comfortably, and beyond
this it appears to me that all learned dissertations on
the true form of the stethoscope are pedantic and use-
less. Practically, I have not been able to distinguish
any difference in the sound-transmitting powers of the
various forms of this instrument ; and when I find that
with any ordinary stethoscope I can detect sound if the
distal end be merely touched with the end of a fine
human hair, it seems to me that for all practical pur-
poses this must be more than sufficient. It is often
well to listen both with and without the stethoscope in
the same case.

In performing careful auscultation, it is necessary :
1. That the chest should be bare, or if this is incon-
venient, then it should be covered by a thin shirt
only, or a towel. 2. The stethoscope must be applied
firmly, closely, and' accurately but not heavily to the
chest. 3. The ear-piece must be accurately applied to

AUSCULTATION.

133

the ear. 4. All friction from the clothes, &c., of the
patient, and the hair and hands of the operator, must
be guarded against. 5. The patient should be placed
in a position most comfortable to himself and convenient
to the operator. The sitting position is usually the
best, the arms and muscles of both sides being kept
arranged symmetrically and in complete repose. When
examining the front of the chest, the arms should
be crossed in front. When examining the lateral
regions, the hands should be crossed over the head.
The auscultator must place himself in an easy position,
and avoid stooping with his head as much as possible.
The kneeling position, one or both knees on a hassock,
will often be found convenient. 6. The sounds pro-
duced by ordinary breathing and forced breathing should
both be listened to. 7. Be careful not to mistake
sounds produced by external frictions, or sounds pro-
duced by the muscles, or in the throat, nose, or stomach
of the patient for the pulmonary sounds. 8. It will
often be found necessary to listen again and again, and
for a considerable time, before the truth is arrived at,
and this especially with females, or with the nervous,
or where there is spasmodic disease. 9. In many
cases it may not be necessary, but it is generally
advisable, and in doubtful cases it is necessary, that
all the regions of the chest should be examined.
10. Neither in chronic nor in acute cases is it gene-
rally necessary to make a minute examination each
visit, unless the changes in the general symptoms are
such as to call for this examination.

The sounds produced by ordinary respiration during
health are caused by the passage of the air through the
I larynx, the trachea, the bronchial tubes, and finally into

134

THE LUNGS.

the ultimate cells. These sounds will vary according
to the size of the passages, but during health it is with
the sounds produced in the ultimate bronchial tubes
and the air-cells that we have to treat of.

The sound produced by ordinary respiration in health
is called sighing, or breezy, and resembles the gentle
sighing of the wind in a forest of trees. But I may
observe, as this sighing sound in a forest of pines is
different from that produced in a forest of beeches, so
in different individuals there are often modifications in
the clearness, sharpness, and softness of the respiration
sounds.

These variations, like the variations in the pitch and
quality of the voice, are manifold, depending probably
on the size and degree of tonicity of the ultimate tex-
ture of the lungs.

The respiration sounds are caused by air passing
through the ultimate bronchise, and into and out of the
air-cells, and probably also by the expansion of the cells
in inspiration. They are divided into those of inspi-
ration and expiration. The sounds of inspiration are
normally more prolonged and more audible than those of
expiration, indeed, the sounds of expiration are often
nearly inaudible. In certain diseased conditions of the
lungs, to be treated of afterwards, as in incipient
tubercle, the passage of the air out of the minute bronchia
would seem to be hindered, rendering sounds of expi-
ration prolonged. The same occurs in old age from the
inelastic nature of the lung tissue.

In children the respiratory murmurs are more sharp
and clear than in adults, partly owing, probably, to the
more perfect texture, and higher vibratory quality of
the lung tissues, but also, I think, to the act being per-

AUSCULTATION.

135

formed with more rapidity, abruptness, and com-
pleteness, and because, as Laennec observes, children
breathe with more fulness, requiring, as they do, more
oxygen than adults. The sound produced by women
generally, but especially by nervous or hysterical
women, resembles or surpasses infantile breathing in
sharpness. Those of the sanguine temperament gene-
rally give clearer sounds than the lethargic, and as a
rule clearness of sound decreases with advancing years.

The sounds are obscured more or less in proportion
to the thickness of the fat and muscle covering the
chest.

As in percussion some healthy chests are unusually
dull, and others unusually clear ; so in auscultation, the
respiratory murmurs of some, especially nervous, indi-
viduals, are clear and sharp, and even puerile, and that
to old age ; while in others, and these may be strong
individuals, the respiratory murmurs are, even on full
inspiration — in some cases only occasionally, in other
cases habitually — nearly inaudible.

This weakness of respiratory sound may be owing
sometimes to a laxity and want of elasticity in the
quality of the lung tissue, but it seems to me as if it
also were sometimes caused by a certain stiffness of the
parietes of the chest, or lethargy of the individual, and
also, at least when the patient is under examination,
by the habit, as it were, of bronchial instead of vesicular
breathing ; further, a certain amount of nervousness
during examination may possibly cause, from spasm in
the minute bronchia, a want of vesicular breathing.
Sometimes the respiration is not heard, because the
patient makes abortive efforts when desired to breathe.
In such cases, if we desire him to cough or to count

136

TIIE LUNGS.

twenty aloud and quickly, lie will instinctively after-
wards take a full and free inspiration. From the above
it will be perceived why weak respiration over the
entire lung is generally a less important sign than local
weakness in the respiration. It is important to know
of this habit of weak breathing. A young gentleman,
a patient of mine, was, against my protestations, some
years ago banished to Australia, chiefly because a phy-
sician found his respiration sounds very weak !

RESPIRATION SOUNDS IN DISEASE.

Exaggerated respiration may arise from a nervous or
spasmodic condition, or from the rapid breathing of
inflammation, or from one lung, or part of a lung,
being impervious, thereby throwing extra labour on the
other lung, or on the parts adjoining the impervious
parts. The lung tissue (the muscular tissue of the
lungs ?) may be hypertrophied and produce exaggerated
respiration.

Weak respiration may be local or general from ner-
vousness, debility, or paralysis, or from some obstruc-
tion in the bronchia of a tubercular, cancerous, or
inflammatory nature ; or from pressure on a bronchus —
as from a tumor or an aneurism.

Suppressed respiration may result locally from emphy-
sema— tubercular, or other infiltration, hydrothorax,
pneumo-thorax — but some nervous individuals while
under examination, may have, within one quarter of an
hour, harsh respiration, weak respiration, suppressed
respiration. Forced inspiration often produces no
vesicular sound, and many patients when requested to
draw a full breath, produce only bronchial sounds. If

RESPIRATION SOUNDS IN DISEASE.

137

such individuals he desired to count up to 100 rapidly,
they will get out of breath, and then draw a full
vesicular inspiration.

Jerking or broken respiration, in which there is a
series of divisions in the inspiration, may exist through-
out the lungs in hysteria, spasmodic affections, spinal
irritation, intercostal neuralgia, incipient pleurisy, or it
may be found locally in tubercular or other infiltration,
and in pleuritic adhesions.

Divided respiration signifies that lengthened interval
between the end of inspiration and the beginning of
expiration, instead of that almost imperceptible interval
which exists in normal breathing.

The sign occurs in emphysema or in an inelastic con-
dition of the ultimate tissue of the lungs, and in tuber-
cular infiltration.

Deferred inspiration is said to occur when the
“ closing instants” only of inspiration are audible. It
may occur in emphysema. Is this when the fine
vesicular tissue existing at the final termination of the
bronchia is opened up, viz., after the larger bronchia
have become filled with inspired air ?

Unfinished inspiration — viz., when the chest continues
to expand after the inspiration sounds have ceased —
is said to occur in consolidations of various kinds. Is

• this from an instinctive effort to obtain more air after

• the limited vesicular tissue is supplied ?

Prolonged expiration. — Instead of the expiration

• sounds being shorter in duration than those of inspira-
tion, as is usually the case, they may be much longer.
This may arise from tubercular or other obstructions,
or from bronchitis, but more frequently in emphysema,
viz., from a want of contractile power in the lungs.

138

THE LUNGS.

This phenomenon is said to exist normally in some
individuals, and especially in females, and at the right
apex.

“ Cogged wheel ” respiration resembles jerking respi-
ration, and is supposed to indicate the action of the air
breaking through interruptions to its progress, caused
by the agglutination of the minute bronchia by tena-
cious mucus. It is often found in the neighbourhood of
tubercular deposits.

Harsh respiration, as a substitute for the breezy re-
spiration of health, occurs chiefly in inspiration in a dry
state of the mucous membrane of the fine bronchia, or
in vesicular emphysema, or in pleurisy, or the resolu-
tion stage of pneumonia; or if there be tubercular,
pneumonic, or other deposit in the finer tubes and air-
cells, as in incipient phthisis ; and in cases of consolida-
tion of portions of the lungs, from whatever cause.

Harsh respiration is closely allied to bronchial respi-
ration.

Blowing, or bronchial respiration, may be regarded as
a further development of harsh respiration. Harsh re-
spiration, as we have seen, depends on dryness, or
roughness, or impediments in the minute bronchia and
cells, &c. ; blowing respiration is an advancement of this,
viz., when these ultimate tubes and cells having become
blocked up, the respiration is restricted to the larger
bronchi. Accordingly, blowing respiration is heard best
in pneumonic hepatization and abscesses of the lungs.

There are two varieties, diffused and tubular. The
diffused occurs, probably, when the occlusion of the
bronchia is incomplete ; the tubular, when respiration
is entirely confined to the large bronchi.

Tubular breathing has a hard, metallic quality of

RESPIRATION SOUNDS IN DISEASE.

139

sound, and the sensation to the listener is as if the air,
during inspiration and respiration, were being drawn
away from and being puffed back again to the ear.

Dilatations of middle-sized bronchia will produce the
diffused variety of blowing respiration. Laennec says
this breathing is one of the earliest signs of tubercular
accumulation ; and Dr. Walshe draws attention to the
important fact that, owing to the condensation around
a cavity, blowing respiration may be produced, masking
the true cavernous breathing, which may not be de-
tected unless carefully sought for. In certain cases of
enlarged bronchia, or of tumor connected with a large
bronchus, or of pneumonic consolidation near a large
bronchus, blowing respiration may simulate cavernous
breathing. In the first instance, because a large bron-
chus is analogous to a cavity ; and in the second case,
because a tumor in connection with a bronchus will in
certain cases intensify the bronchial blowing sound, or
bring the respiration of that bronchus, by conduction,
closer to the surface of the chest.

Pleuritic adhesions and effusions, by preventing the
expansion of the cellular tissue, may produce diffused
blowing respiration, and mislead into the idea of hepa-
• tization.

Cavernous breathing resembles the tubular, the air
being as it were drawn from and driven into the ear of
the listener, with distinctness in proportion to the proxi-
mity of the cavity to the surface. But, as a cavity is
not often so smooth or elastic as a bronchus, the sound
is less ringing and metallic, but more hollow. A cavity
may exist, and yet if there be no large bronchus opening
into it, or if the bronchus opening into it be temporarily
1 closed, no cavernous breathing will be found. If the

o •

140

THE LUNGS.

bronchus opening into it be filled with pus, the respira-
tion will produce cavernous rhonchus.

A dilated bronchus, surrounded by dense tissue, may
simulate cavernous breathing.

Tuberculous excavation is the chief cause of cavities,
such being comparatively rarely the result of cancer,
abscess, gangrene, or pulmonary apoplexy.

Amphoric breathing (cifujjoptvg, a hollow measure)
is the name given to the breathing sound produced
in a very large cavity, — so large as rarely to occur
in the lungs, but is sometimes produced by a tuber-
cular fistulous opening from a good-sized bronchus
into the pleural cavity, which becomes more or less
hollow from the entrance of air, — hydro-pneumothorax
being its usual anatomical cause. The sound resembles
that produced by blowing into an empty glass or other
bottle.

Rhonchi , rattles , or rales , are the names given to the
abnormal sounds produced in the bronchia during respi-
ration.

They are dry or moist, and depend on alterations in
the calibre of the bronchia or — and this is the chief
cause — in alterations in the amount or quality of the
fluid contained in the cells and bronchia, or it may be in
certain cavities.

The moist sounds are produced by the bubbling of air
in the fluid contained in the bronchia, or in certain
vibrations caused in the bronchia by the bubbling of
fluid, or from strictures in the bronchia of a spasmodic,
mucous, or permanent nature.

Whispering , or sibilant rhonchi, may be imitated by
blowing through the nearly closed lips with saliva inter-
posed; and, conjecturally, sibilant rhonchi are pro-

RESPIRATION SOUNDS IN DISEASE. 141

duced in the fine bronchia, owing to the presence of
viscid mucus.

Coughing, by displacing the mucus, may cause this
sound to disappear.

Sonorous rhonchi are grave in tone and dry in cha-
racter; of various degrees of loudness, and may be
snoring, nibbing, or cooing in character. They are
caused by the presence of viscid matter in the large
tubes ; although they may also be caused by spasms, or
by constriction through pressure on the tubes. The
cooing musical sound sometimes heard is caused by the
vibration of the bronchia, called into action, probably,
by the unequal calibre of the tube, from the presence of
i stricture caused by tenacious mucus.

Crepitant rhonchi are, as Dr. Williams observes, ex-
actly like the sounds produced by rubbing between tl
:finger and thumb a lock of the hair close to the ear /
they may be likened to the sound produced by .

- effervescing of aerated waters.

They are heard best on inspiration, as in the early
'Stage of pneumonia.

One theory is, that crepitant rhonchi are produced by
r the bursting of bubbles of air through fluid ; another
theory is, that they are caused by the air expanding, and
;hus separating the lightly agglutinated ultimate tissue
}f the lungs.

The second theory seems to me the more probable :
— 1. Because a sound closely resembling it may be
| iroduced by separating any thin membrane from a
ticking surface. 2. Because it is heard chiefly on in-
piration, viz., when the long tissue expands, and tliere-
ore the walls of the ultimate bronchia and cells are
I eparated. 3. Because it sometimes occurs in pure

142

THE LUNGS.

oedema of the lungs, viz., in a state which must tend to
compress the lung tissue, and in which no adventitious
fluid is present.

Dry cr adding rhonchi are heard entirely on inspiration,
and may he characterised as an exaggeration of the
crepitant just described ; but producing only a few
large cracklings, instead of an infinite number of small
ones, as in effervescence.

This rhonclius is heard often at the apex of the lungs,
“ on the eve of the softening process in tubercle,” in
which we may suppose the presence of a glutinous
exudation, which causes the minute walls of the tubes
to adhere, and which must be separated by the entrance
of air.

Moist crackling or clicking rhonchi is a further
development of the above, and in which the exudation
of viscid matter has become more copious. This also is
heard in the incipient softening of tubercle.

Bubbling rhonchi may be small or large, according to
the calibre of the bronchi, through which the air-
bubbles, in passing through mucus, pus, or blood, as in
bronchitis, tubercle or pneumonia.

If the sound be heard at the bases of the lungs, it is
most probably from capillary bronchitis; if at either
apex, it is most probably from tubercular bronchitis ; if
at one base, most probably from pneumonia.

Hollow bubbling rhonchi are heard in dilated tubes,
or in tubercular or other cavities containing fluid.

But they will not be heard in cavities, if these con-
tain no fluid ; or, if the cavity contain so much fluid
that air cannot enter; or, if the bronchus enter the
cavity above the level of the fluid, or, if the bronchus
itself be plugged up.

RESPIRATION SOUNDS IN DISEASE.

143

Coughing and expectoration may cause this bronchus
to disappear for a time, or, as in the case of plugged
bronchus, coughing may cause the rlionchus to re-
appear.

This rhonchus, if it proceed from a cavity, and the
cavity be smooth and compact, produces an echoing
sound in the cavity.

A dry crackling sound lias been occasionally heard,
giving the idea of air distending dry emphysematous
tissue.

Pseudo rhonchus is a name given to the sound occa-
sionally heard on full inspiration at the bases of the
lung, and probably produced by the expanding of air-
cells, which are not expanded by ordinary breathing.
It may occur in cases where the bases of the lung have
been compressed by abdominal tumors. It disappears
after a few full inspirations, thus distinguishing it from
< crepitant rhonchus.

I have already described the vibratory sensations
communicated to the walls of the chest by the action of
‘the rhonclii — vibrations much in proportion to the size
of the bronchia implicated.

The indications furnished by rhonchi are evidently
■sufficiently clear, viz., for the most part the presence of
adventitious fluid of variable quality, and existing in vari-
; able quantity in the cells, or in bronchial tubes of all
;■ sizes, or in cavities.

Pleural friction sounds . — In health the costal and
aulmonary pleune being lubricated by a serous fluid,
I- glide noiselessly on each other, during the rising and
ailing action of inspiration and expiration. If, how-
ever, there be any roughness caused by inflammatory
>r other deposit, a friction sound is produced — loud

144

TIIE LUNGS.

in proportion to the roughness of the surfaces ; some-
times resembling the rubbing of the finger over bone,
at other times resembling the creaking of leather.

Slight grazing friction may be heard in the early
dry stage of pleurisy, but most frequently in tubercular
pleuritic affections, and is usually of only short duration,
soon giving place to rougher sounds.

Pleurisy is the great cause of friction sounds, but
no friction is heard so long as the fluid effused is suf-
ficient to separate the pleural surfaces. However, in
some instances, the pleural surfaces may be locally
attached by adhesions, and, in such cases, friction is
compatible with extensive effusion. Friction sounds
are usually best heard on inspiration. They are fre-
quently heard on both inspiration and expiration, and
occasionally on expiration only.

Laennec believed that interlobular emphysema some-
times caused friction sounds. Most subsequent writers
have denied this. Hr. Walshe is inclined to believe
that occasionally interlobular emphysema does produce
friction sounds, especially at the posterior base of the
lungs; but it seems to me that this can only be, if
some roughness, dryness, or vascularity accompany the
emphysema ; and doubtless, if an emphysematous
bladder be large, it is likely to be ill supplied with
vessels, and therefore dry , and hence friction may be
produced.

Friction sounds produced by inflammatory exudation
may rapidly and permanently disappear, or they may
remain permanently ; in which case there is also some-
times a permanent local dulness on percussion ; and as
this state of things may be found in individuals per-
fectly healthy, it may be necessary, on making the dis-

VOICE RESONANCE.

115

covery on examination to question the patient as to
any former attack of pleurisy ; although, as in the in-
stance of latent pleurisy, the patient may be quite
unable to afford any information.

Sounds may be heard on auscultation simulating
friction or pulmonary sounds, hut arising, it may he,
from the movements of the muscles, the movements of
the scapulae, the cartilaginous joints of the ribs, or from
. gurgling of the stomach or in the throat ; or from hairs
of the body rubbing on the stethoscope ; and in disease,
from the stethoscope pressing on an emphysematous or
anasarcous skin. But a little attention only is sufficient
to detect the source of such sounds.

VOICE RESONANCE, AS HEARD IN THE LUNGS DURING

HEALTH.

If the stethoscope be applied over the larynx or tra-
chea, and the individual speak with a distinct voice, the
-sounds heard are loud and buzzing, and are called
natural laryngophony and natural tracheophony (< piovr j,
the voice, or sound) . If the stethoscope he applied
over the upper middle part of the sternum, or between
t the scapulse, the bronchial voice sound, or bronchophony,
will be heard, and so on, the further we listen from the
! main bronchi to the sound of the voice, the weaker the
vibratory sounds appear, until at the circumferential
r. parts of the lungs there is heard only a distant buzzing
-sound.

The deeper and stronger the voice, the greater will
I be the resonance, and lienee it is much stronger in the
\ male than in the female, while in individuals having
■ small voices little or no resonance may be heard at a

146

THE LUNGS.

short distance from the main bronchi. Vocal resonance
being generally greater on the right side, this must not,
if found, be mistaken for a morbid sign, and it is greater
in the aged than in the young, owing to the harder and
more vibratory nature of the bronchial tubes.

One authority says there is no explanation why the
vocal resonance should be louder below the right than
the left clavicle, but I would ask, are the facts of the
right bronchus having a larger calibre, and being higher
up than the left, not a sufficient explanation ?

As in respiration and percussion sounds one individual
may produce much clearer sounds than another, although
both lungs are equally healthy, so in voice sounds two
individuals with equal health and equal voices may yet
produce vocal resonance the one greater than the
other.

Vocal resonance in disease may be locally or generally
weakened or suppressed by the presence of mucus, or a
tumor, or anything which will interfere with the trans-
mission of vocal vibrations through the trachea or
bronchi.

Vocal resonance will generally be impaired by the
presence of emphysema, or pneumothorax, or copious
pleuritic effusion.

Increased resonance , or morbid bronchophony , will be
heard if the lung-tissue be condensed from the presence
of tubercles or inflammatory deposit, or if compression
has resulted from pleuritic effusion, or if a tumor com-
municate between the stethoscope and a bronchus, or if
there be enlargement of a bronchus, also in some cases
of cavity.

If the lower part of the lungs be compressed during
pleuritic effusion, the upper part of the lungs may yield

VOICE RESONANCE.

147

increased bronchophony, and, what may appear a con-
tradiction, increased bronchophony accompanies some
^ases of emphysema, perhaps from enlarged bronchia,
>r, it may be, from increased consonance.

Increased resonance would appear to be chiefly caused
iy condensed tissue transmitting the laryngeal vibra-
xons better than aeriform tissue. Increased resonance
iccurring at the upper part of the lungs when the lower
.art is compressed by pleuritic effusion, seems to me to
• e because the voice sounds are thus cut oft’, as it were,
:om being dispersed.

Increased resonance, in some cases of emphysema, is
recounted for by what is called “unison resonance,”
ist as the tones of a fiddle or a guitar are increased by
le air-box to which the strings are fastened. Hence the
"onchophony, it is said, may be louder than the sound
ard over the larynx itself.

Skoda denies that bronchophony is heard owing to
e conducting power of the walls of the bronchial tubes,
of condensed tissue, and says it is rather owing to
nsonance, or reproduction of sound in the tubes com-
unicating with the laryngeal voice ; as an instrument,
mding by, although not struck, may consonate with
voice or with another instrument, when struck.

The dispute is not pathologically or clinically of much
portance, but it seems to me unquestionable that
idensed tissue will transmit sounds better than aeri-
al tissue, and also that tubes surrounded by dense
me will yield louder vibrations than if surrounded by
se tissue, just as a tuning-fork vibrates louder on a
| ’d board than on a soft board. But for a long and
rned discussion on this subject, I can refer the
der to Dr. ’VYalshe’s book f On the Chest/ pp. 142 — 53.

148

THE LUNGS.

Pectoriloquy [pectus, tlie chest, and loquor, to speak)
is the term given to the distinct voice sound which is
heard through the stethoscope if a tumor communicate
between a large bronchus and the chest walls, or if a
bronchus open into a cavity. It resembles the sound
heard over the larynx.

A large cavity may exist, but, if deeply seated, or if
it have soft walls, or if it do not communicate with a
bronchus of some size, no pectoriloquy, even with loud
speaking, may be heard. On the other hand, if the
walls of the cavity be compact, and the cavity near the
surface, with a bronchus opening into it, the merest
whisper will be heard, and sometimes with startling
distinctness.

If the cavity be very small, or if it be very large, or
if the bronchus communicating with it be plugged up,
or if the cavity be filled with pus, or if there be many
bronchial communications with it, there may be no pec-
toriloquy. The absence of this sign is, therefore, no
proof of the absence of the cavity ; while, as a tumor
may cause it, pectoriloquy is no proof of a cavity. But
whispering pectoriloquy — that is, pectoriloquy heard on
the patient merely whispering — is nearly an absolute
proof of the existence of a cavity.

( Egophony , or goat voice (at£ and (porri), or Punch-
like voice sound, is occasionally heard through the ste-
thoscope as the patient speaks, when, as is supposed, a
thin layer of dropsical or pleuritic fluid intervenes
between the pulmonary and costal pleurae. It is pro-
bably caused by certain vibrations of the lungs being
interruptedly broken by the layer of fluid, or perhaps
by certain vibrations caused by the concussion of air
displacing the fluid.

GENERAL SUMMARY OF PHYSICAL EXAMINATION . 149

Amphoric echo is a sound somewhat like that pro-
duced by blowing into an empty decanter — Laennec
says like the echo in an empty cask.

Metallic tinkling is like the sound produced by striking
| a large glass vessel with a pin.

The echo occurs with coughing or speaking, and is
i supposed to be owing to a large cavity — it may be to
j pneumothorax — echoing with the neighbouring bron-
; chus, or with a bronchus opening into the cavity ; and
the tinkling is supposed to be owing to the concussion
; of the fluid in that cavity, or the echoing of exploded
i bubbles of air.

The heart sounds are generally transmitted with in -
creased distinctness to different parts of the lungs if
there be tubercular or other condensation, and the
reverse in emphysema.

If a patient having a large cavity containing fluid, or
having pneumo-hydrothorax, be shaken by coughing,
riding, or walking, or by another person, a splashing
sound has sometimes been heard by the observer, and
j even by the patient himself. This is a fact which was
known to Hippocrates.

! GENERAL SUMMARY OF PHYSICAL EXAMINATION OF THE

LUNGS.

In the foregoing pages I have endeavoured, as briefly
md as closely as possible, to enumerate the physical
iigns furnished by the lungs in health and disease, and
:o explain the mechanism or cause of these signs, and
;heir relation to diseases. But it may be well to cndca-
our to give a more summary view of these signs, in

150

THE LUNGS.

order to enable the mind to take a concentrated, yet
comprehensive, grasp of the subject.

Inspection of the naked chest shows size, form, sym-
metry, texture and colour of skin, expansive power,
bulgings, depressions ; from which we form opinions as
to the presence or absence of general health, tubercle,
aneurism, emphysema, tumors, &c.

Application of the hand enables us to judge of the
amount of vibration which takes place when the patient
speaks or coughs, and may afford some information as
to the presence or absence of tubercular or other depo-
sits, enlargement of bronchi, pleuritic friction, expansive
texture of the lungs.

Mensuration of the chest by a tape will give the differ-
ence of circumference between full expiration and full
inspiration, but much less instructive information than
that furnished by inspection.

Percussion , in health, yields sounds tympanitic over
the intestines ; clear over the lungs ; duller over solid
organs, as the heart and liver ; and dead over water, as
over the chest in pleuritic effusions or hydro thorax.
In disease, percussion sounds are either abnormally clear
or abnormally dull, in direct relation to the amount of
air, solid matter, or water present, and thus afford us
information as to the presence or absence of, e.g. air
plus — emphysema, enlarged bronchi, (tumors communi-
cating with bronchi,) pneumo-thorax ; e. g. solids plus —
tubercle, cancer, tumors, enlarged solid organs, aneu-
isms, pneumonia; e. g. fluid plus — hydrothorax, pleuritic
effusion, abscess, empyema.

Auscultation of the lungs, in disease, furnishes in-
formation as to the sounds during respiration, and
during speaking or coughing, arising in the cells, in

GENERAL SUMMARY OF PHYSICAL EXAMINATION. 151

the bronchi, and in cavities ; also over tumors or conso-
lidations communicating with bronchi or cavities ; also
information as to friction sounds.

Respiration sounds, in disease, may be increased,
diminished, or absent, locally or generally. They may
be jerking, divided, prolonged, “ cogged-wheel/’ harsh,
blowing, cavernous, crackling, rattling, snoring or bub-
j bling, wheezing, whistling, or cooing.

Respiration sounds are exaggerated in hysteria, in
asthma, or if one lung has extra work, the other being idle.

Harsh (may be) in vesicular emphysema, pleurisy,
resolutive stage of pneumonia, incipient phthisis.

Weak from debility, paralysis, or obstruction, or
idiosyncrasy.

Suppressed, locally, from emphysema, tuberculous or
other deposit; general, from liydrothorax, pneumonia,
pneumothorax, or obstruction in main bronchus, or by
phlegm in bronchitis, or from tumors.

Jei'king, hysteria, spasm, pleurisy, tubercle, &c.

Cogged-wlieel inspiration — tubercle, viscid mucus.

Divided, that is, an interval of rest between inspira-
tion and expiration, in emphysema, or want of elasticity
in lungs, or tubercle.

Deferred inspiration, viz., when the terminal part
only of inspiration is heard — emphysema (?)

Unfinished inspiration, viz., when the chest continues to
expand after inspiration sounds have ceased — tumors (?)

Prolonged expiration — bronchitis, tubercle, emphy-
sema, deficient elasticity.

Blowing or bronchial respiration indicates blocking
up or destruction of the vesicular tissue, as in pneu-
monia, abscess, &c.

Cavernous respiration, like bronchial, but more hollow,

152

TIIE LUNGS.

indicates cavity, enlarged bronchus, or tumor inter-
vening between bronchus and cliest-walls.

Rhonchi or rattles are fine, or dry, or moist, or
coarse, according to the quality or quantity of the fluid
in the bronchi ; and are whispering, crepitant, or
crackling, sonorous, cooing or bubbling, &c. ; they in-
dicate the presence of fluid (or oedema rarely) in the
cells, or fine or large bronchi, and are found in
tubercle, pneumonia, capillary or other bronchitis, and
in cavities.

Pleural friction sounds, varying from the “ rustling
of silk” to the “ creaking of a saddle,” indicate the
presence of roughness from dry surfaces, or from con-
gestions or exudations.

Vocal resonance, viz., natural bronchophony —

Weak or suppressed, locally or generally, from ob-
struction, solid or fluid, in the bronchi or the main
bronchus, in emphysema, pneumothorax and hydro-
thorax.

Increased resonance, or morbid bronchophony, from
enlarged bronchus, tubercular or other condensation of
lung, a tumor communicating with bronchus.

Pectoriloquy is the name given to the bronchophony
furnished by a cavity ; but may be heard if a tumor
communicate between a large bronchus and the chest-
• walls.

(Egophony , or Punch-like voice, indicates usually the
presence of a thin layer of fluid in the pleura, thrown
into vibrations when the patient speaks.

By the study of the above abstract it will be seen that
any one given sign may indicate more than one dis-
ease, and that almost every chest disease furnishes
several signs.

PLEURODYNIA.

153

For example, pectoriloquy is a sign of cavity and of
its opposite tumor.

Jerking inspiration is a sign of incipient tubercle or
of mere nervousness.

Prolonged expiration is a sign of tubercle, and of
what may be called, pathologically and anatomically,
its opposite — emphysema.

It therefore follows, that all the signs, in all their
bearings, must be well understood, and that no disease
can be diagnosed from one sign ; further, that it may
mislead the mind to trust too confidently to the diag-
nostic evidence furnished by physical signs only ; because

I man, when diseased, must be considered in all his rela-
tions as a human being, and not merely as a cunning
musical instrument, more or less out of tune.

DISEASES OF THE LUNGS, &c.

Pleurodynia (7rX£i»pa and aSwi] pain), “false pleurisy,”
viz., rheumatic or neuralgic darting or gnawing pains
in the muscular and fibrous tissue of the walls of the
chest, is usually, except in nervous females, unaccom-
panied by fever, but by acute pain on motion of the
arms or body, sometimes pain on pressure, and gene-
rally also during the respiratory movements. In con-
sequence of this pain in breathing, the patient draws
his breath very carefully, and hence there may be little
audible vesicular respiration. It is distinguished from
pleurisy by the absence of dulncss on percussion or
friction sounds, and also by the absence of rigors and
of an inflammatory pulse, this last symptom being,
however, often absent in pleurisy of the passive kind.

154

THE LUNGS.

The pains may extend to the abdominal walls, and
may give rise to a suspicion of peritonitis, especially as
there may be tenderness on pressure, but the absence of
rigors, fever, and of the suspicious, anxious expression
of peritonitis, &c., will enable us to distinguish the
disease.

Cold caught by exposure to damp, or sitting exposed
to draughts, whereby the perspiration may become
checked, is the usual cause of the attack.

The Allopathic treatment recommended is cupping,
rubefacients, Colchicum, &c.

The Homoeopathic treatment will consist in the use
of Aconite, Arnica, Bryonia, Nux Vomica, Pulsatilla,
and Rhus. Tox. Bryonia, I believe, will be found the
most usually serviceable, especially in robust men.
Pulsatilla will often respond, especially in the case of
nervous females. Homoeopathic writers appear, gene-
rally, to prefer Arnica to other remedies.

The hot bath, or the hot-air bath, and frictions with
the hand and warm oil, will also afford much relief.
In some cases, the “wet sheet pack” may be advisable.
The patient should be kept comfortably warm, and the
diet should be simple and generally unstimulating,
although, in cases of long standing, accompanied by
debility, a generous diet may be serviceable.

In the treatment of pleurodynia, I should usually
prefer the 3d centesimal dilution, and in doses of a tea-
spoonful every one, two, three, four, or eight hours,
according to the intensity of the pain.

INTERCOSTAL NEURALGIA.

Intercostal Neuralgia resembles pleurodynia in its
symptoms, but the pain is more in the lines of the

INTERCOSTAL NEURALGIA.

155

intercostal nerves, and more especially, it is said, at tlie
beginning, middle, and end of these nerves, viz.,
near the spine, below the axillae, and near the sternum,
thus distinguishing it from pleurodynia and pleurisy.
It is often in the female found associated with neuralgia
of the mammae, and is frequently coexistent with
phthisis.

Intercostal, like other neuralgia, is found chiefly in
the debilitated, although also in the plethoric.

The Allopathic treatment consists in leeches and
blisters, followed by Aconite, Belladonna, and Morphia,
endermically applied ; or the internal use of Quinine,
Arsenic, or Iron.

The Homoeopathic treatment will consist in the use
of one or more of the following remedies : Aconite,
Arnica, Belladonna, Arsenic, Bryonia, China, Colo-
cynth, Ignatia, Nux Vomica, Pulsatilla, Spigelia, Sta-
physagria. Sepia,. In the dilutions used the prefer-
ence, in many cases, will be for the higher ones, viz.,
the 6’, 12°, or 30° centesimal.

The medicines selected will depend a good deal on
whether the patient is of a debilitated or plethoric
habit. In the first case. Arsenic, China, Sepia., &c. ;
and in the second case. Aconite, Bryonia, Arnica, &c.,
will suggest themselves.

As in pleurodynia, much relief will often result from
manual frictions, in the direction of the nerves, from
the spine to the sternum.

Pulvermacher’s galvanic chains have often been worn
with advantage.

156

THE LUNGS.

NEURITIS.

Neuritis , or inflammation of the intercostal nerves,
will, in its symptoms, resemble intercostal neuralgia,
but the pain will be more constant and less acute.

Aconite, Bryonia, and Belladonna, are the remedies
to be employed in neuritis.

ACUTE BRONCHITIS.

Acute Bronchitis is undoubtedly the most frequently
occurring acute disease of the lungs which appears in
this country, and the annual mortality from this
disease, especially among the aged, is very great.

Acute bronchitis may supervene on tuberculous or
cancerous deposit, or on typhus fever, or in suppressed
eruptive diseases, or in hooping-cough, &c. ; but the
majority of the cases met with are purely idiopathic,
and generally ascribed to exposure to cold or wet.

It is a disease which frequently begins with catarrhal
symptoms, and passing down the bronchial tubes, first
shows itself in the large bronchi, from which it may
descend to the capillary bronchia.

The tongue is white and coated, or brown and foul.
Exacerbations are apt to occur during the night, from
the accumulation of phlegm.

The mucous membrane of the bronchi is congested,
and epithelial desquamation takes place in patches.

The cough is generally very violent, and blood may
be mixed with the sputa, varying from a few blood-
discs to streaks of blood.

The sputa are generally white and frothy, but they

ACUTE BRONCHITIS.

157

may be bluish -black, thick and tenaceous, or muco-
purulent.

If the disease be confined to the larger bronchi, it
is comparatively an unimportant affection, but if it
descend to the minute branches, then the oxygination
of the blood becomes imperfect, the symptoms being
those more or less of suffocation, with dusky face, and,
in fatal cases, the gradual progress of coma from brain
congestion, or of asphyxia, from the blocking up of the
minute bronchia. It may be very insidious in its
attacks on young children and the aged, and in such
cases is often fatal.

“ In capillary bronchitis the lungs are generally dis-
tended with air, and sometimes acutely emphysematous ;
hence there is a general increase of bulk, but here
and there the surface is the site of collapsed lobules,
airless, and quasi solid.”

The respirations are hurried, and may be 50 in a
minute, while the pulse may be as high as 150.

The paroxysms of dyspnoea may be most acute, and,
if the patient be not relieved, he gets more and more
asphyxiated, and weaker and weaker ; the skin becomes
cold and clammy, the eyes suffused, the lips purple,
the breath cold, and the patient passes away in drowsy
fits or in low delirium.

The Physical Signs. — In the dry stage the breathing
sounds may be sonorous or sibilant, but this stage is
usually so brief in duration, that dry respiration
sounds are seldom heard. Ilhonchal fremitus is pro-
duced. The rhonchi are generally bubbling ; but
locally, the respiratory sounds may be absent, from
the complete blocking up of the tubes with phlegm,
the ronchi reappearing probably after expectoration.

158

THE LUNGS.

Contrary to wliat might be anticipated from the im-
mense amount of phlegm present in the bronchi, the
percussion sounds are as clear as in health, probably
because so much air is held imprisoned in the phlegm.

Should the bronchitis result from tubercular or other
deposit, the local percussion sounds will of course be
dull. Should there be any portion of the lungs clogged
up with phlegm, and the air be thus excluded, the per-
cussion is dull, especially about the base of the lungs,
which may be clogged up from the gravitation of
fluid.

Fine bubbling rhonchi, confined to the apices or to
one base, is generally tubercular, but it may be emphy-
sematous.

This disease can scarcely be mistaken for pneumonia,
owing to the general absence of dulness on percussion,
the absence of tubular breathing, and the absence
of the rusty sputa. As young children, however,
generally swallow their sputa, this last sign will be
wranting in their case. Bronchitis may assume a
typhoid character, but this must be distinguished from
that bronchitis which often supervenes on typhus fever.

The mortality occurring in the acute bronchitis of
the larger tube is, even under the heroic treatment of
the old school, very small, unless in infants, old indi-
viduals, or in those worn out by disease.

Treatment. — One modern allopathic writer of cele-
brity says, “ The treatment of acute bronchitis is per-
fectly simple ; we have only to bleed generally and
locally, and give mercury” ! Another high authority
says, “ Bleeding to twelve or fourteen ounces is ad-
visable ;” but adds, “ The patient will require all his
strength to carry him through the asphyxiating stage.”

ACUTE BRONCHITIS.

159

The same author recommends “ cupping to six or eight
ounces, or the application of twenty leeches as a
beginning j” and says, “ Tartar emetic is the most effi-
cient agent known in controlling acute bronchitis, but
not so demonstrably efficient as in pneumonia.” We
shall afterwards see that the tartar emetic treatment of
pneumonia produces, or is followed by, a mortality
of twenty per cent, in the cases. How injurious,
then, according to our author, must it be in bron-
chitis.

If there be depression, instead of tartar emetic,
calomel and opium are recommended ; but surely this
must be bad treatment, for although calomel, by purg-
ing the liver and bowels, may relieve the chest, yet
it has no specific action on the lungs, and is besides
a depressing medicine. As for opium in full doses,
i t is difficult to see what it can do more than still
airther depress the patient, and add to the danger
which already threatens him, Hz., an inability to
i lislodge the phlegm ; and further produce a tendency to
;ongestion of the brain. Concerning the use of dia-
dioretics, expectorants, and mustard poultices, this at
east can be said, that they cannot do so much mischief
i\8 bleeding or tartar emetic.

The heroic system, however, is not only recommended
i n books, but put into active operation up to the present
i ay, as the following history will show :

Mrs. C. B — , set. 78, had at intervals been for
■ ears under homoeopathic treatment, from which system
he invariably derived relief to exacerbations which
i ccasionally supervened on a condition of congestive
lironic bronchitis, but getting impatient of the con-
i nuance of her congestive symptoms, she placed herself

160

THE LUNGS.

under her former allopathic treatment. Shortly after-
wards, one of her usual exacerbations of suffocative
bronchitis appeared. The general practitioner, fearing
the result, called in a “ noted London physician/’ who
immediately ordered cupping between the shoulders to
fourteen ounces. The suffocative symptoms were thereby
relieved, but next day the physician, finding his patient
“ sinking through the bed” from prostration of strength,
ordered brandy to be freely “ exhibited.” Finding in the
afternoon of the same day that the pulse was again up and
the suffocation returning, and fearing a second bleeding,
he ordered blisters to be applied. The patient “re-
sponded rapidly,” but not successfully, to this treat-
ment, and next day she was dead.

I have entered thus particularly into the question of
the allopathic treatment of this disease, because the
arguments of the homoeopath against active treatment
are continually being met by the assertion that the old
school does not now practice heroic treatment as that
was exploded long ago.

The above history is a demonstration to the contrary,
and although I believe it is very probable that the old
lady alluded to would have succumbed under any
treatment to the attack which terminated fatally, yet I
cannot but believe that her death was very materially
hastened by “ the scientific and legitimate” operations
put in force against her.

The homoeopathic treatment of acute bronchitis may
be regarded as most successful. If there be no organic
disease — except in infants, ortlieold and infirm — the mor-
tality probably does not reach five per cent, of the cases
attacked, even with the most acute capillary bronchitis,
while death from pure idiopathic bronchitis of the large

ACUTE BRONCHITIS.

161

tubes may be regarded as under homoeopathy almost
unknown.

According to Dr. Walshe, from 50 to 75 per cent, of
these cases of acute capillary bronchitis attacking young
children and aged persons prove fatal, generally from
the eighth to the twelfth day.

Homoeopathy does not possess any extended statistics
of this form of disease, but if we may judge from the
information supplied by our statistics of pneumonia,
the mortality from acute idiopathic capillary bronchitis
j occurring in young children and aged persons under
homoeopathic treatment should not exceed from 15 to
; 20 per cent.

In the acute bronchitis of the larger tubes, I believe

!no remedies are superior to the alternate use of Aconite
and Bryonia, of the 3d decimal dilution chiefly. Phos-
phorus, Tartar Emetic, and Ipecacuanha, I believe, are
more suitable to the capillary form of the disease,
i. Arsenicum, Nux Vomica, and Lacliesis, are also good
uremedies in this form of the disease, and Sulphur after
.the acute symptoms are past.

Further, Belladonna, Chamomilla, Hepar Sulpliuris,
'Mercurius, Pulsatilla, and Spongia, are recommended
in books. The dose should be repeated every half hour,
br one, two, or three hours, according to circumstances.

In place of the blisters of the old school, manual
Friction with brandy and oil, or oil and turpentine, ap-
.flied over the chest and between the shoulders, may
\ ifford great relief in suffocative bronchitis, with de-
bility. Stimulating rubefacient action, produced by
nanual friction, must be very far preferable to the
lepressing and painful operation of mere blistering,
lot fomentations will also be useful.

162

THE LUNGS.

In tlie old and feeble, brandy and water, or gin and
water, may sometimes be given with advantage.

The inhalation of the fumes of ammoniacal solutions,
by stimulating the bronchi, will act as a useful expec-
torant, especially in debilitated cases. The use of Junot’s
Boot is worthy of consideration, as a relieving pump in
paroxysms of suffocation.

The inhalation of oxygen gas should also be consi-
dered with reference to the asphyxiating stages of the
disease.

Vomiting, induced by tickling the fauces with the
finger or a feather, may relieve the chest of much
phlegm, when coughing fails to produce this desirable
result.

The patient should be kept in a bedroom in which
the temperature is regulated according to his sensa-
tions, and as the disease is one which hinders the free
oxydation of the blood, a good circulation should be
kept up through the room by a fire burning in cold
weather, and by the door and windows being kept open
in warm weather, the danger of an ill-ventilated room
being greater than even a draughty room, although cold
draughts of air must, if possible, be avoided.

The burning of feathers or other pungent substances
in the air will sometimes be found agreeable by the
patient, and the smell of turpentine, ether, or coal-tar,
will also be sometimes relished.

CHRONIC BRONCHITIS.

Chronic bronchitis is a disease which carries off a very
large number of aged people in this country.

CHRONIC BRONCHITIS.

1G3

It interferes with the oxyclation of the blood, causes
a waste of the tissues, and exhausts the vital energy.

It is often a sequel to acute bronchitis or influenza,
cor it may result, in the aged, from a general decay of
nature and relaxation of the lining of the bronchial
cubes.

It frequently exists in knife-grinders, mill-workers,
•masons, and miners, from the irritation caused by the
"fine particles of dust which such individuals are con-
tinually inhaling.

Secondary syphilis, kidney disease, cancer, tubercle,
aneurism, hooping-cough, scarlatina, emphysema, and
asthma, are also occasional causes. Organic diseases of
; ;he heart are also, sooner or later, almost invariably
iccompanied by chronic bronchitis.

It is accompanied by habitual cough, sometimes loose
and easy, at other times violent and spasmodic.

The sputa may be white and frothy, or thick, yellow,

. *reen, or bluish black, and mucous, muco-purulent, or
ms-like. Sometimes, from the violence of the cough,
minute blood-vessels are ruptured, and the sputa is
i treaked with blood. The sputa may be inodorous and
aasteless, or mawkish, or even fetid.

The breathing is usually difficult, especially during
xercise. The aspect is often anxious and distressed,

; nd the complexion dusky ; the eyes are often blood-
liiot, from congestion or the violence of the cough.

The brain is often more or less congested, so also is
lie liver. The tongue may be white and creamy, or
I Dated and brown, and the breath is often foul.

Blueness and coldness of the surface and lethargy of
liind are frequently present, from the deficient oxyda-
it on of the blood.

164

THE LUNGS.

Tlic sbep is fitful or laboured, and, unhappily, is
often followed by an exacerbation of the cough, from
the accumulation of phlegm which takes place.

Syphilitic bronchitis often disappears on the breaking
out of secondary or tertiary symptoms. On the other
hand, it may first appear on these eruptions being
driven in by external applications. Enlargement from
syphilitic periostitis, yielding dull percussion, may,
with the accompanying bronchitis, be mistaken for
tubercular disease.

When chronic bronchitis terminates fatally, it is by
the gradual wearing out of the vital strength, by dropsies,
or by gradual asphyxia, or coma.

The physical signs of chronic bronchitis are usually
sufficiently intelligible, but there can be no doubt that
formerly, before auscultation was practised, and even
now, many cases of chronic bronchitis are set down as
cases of consumption — leading to very serious conse-
quences to the patients.

In chronic bronchitis the chest is often prominent
and bulging, from the presence of emphysema or ge-
neral enlargement of the bronchi — results which may
follow the excessive action of the bronchi and from the
pneumatic straining produced by the constant endeavour
to expel the accumulated phlegm.

The respiration may be harsh, sonorous, whistling,
cooing, bubbling or gurgling — or tubular or cavernous,
over an enlarged bronchus. The voice in such
instances yielding bronchophony, the auscultator
may be misled into the belief of tubercular exca-
vation.

The respiration may be suppressed locally if the
bronchi are plugged up with tenacious phlegm, and at

CHRONIC BRONCHITIS.

165

the base the respiration may disappear, owing to the
gravitation of bronchial fluid.

The percussion sounds arc usually normal, but they
may be abnormally clear if emphysema exist, or if per-
[ cussion be performed over an enlarged bronchus.

Enlarged bronchi are, however, often thickened in
their walls, and surrounded by tissues rendered dense
by inflammatory exudation, in which case there may be
a diminution of normal clearness, or positive dulness.

Dulness on percussion at the base may be mistaken
for pleurisy, but pleurisy is generally confined to one
• side, while bronchitic dulness exists generally at both
bases ; and in bronchitis there is vocal fremitus, but in
pleuritic effusion none.

Phthisis and chronic bronchitis often present many
"signs and symptoms in common — for instance, dull
percussion, pectoriloquy, pus-like sputa or blood-
t- stained expectoration, hectic sweats, and general
wasting. But in phthisis the dulness on percussion, if
; my where, is usually to be found at one apex, while in
:hronic bronchitis the dulness is usually at both bases,
iom the presence of gravitated phlegm, or at the
mpra-mammary region, viz., over the condensed tissue
■ uirrounding the bronchi.

The haemoptysis occurring in phthisis is usually free
' ir frothy, while that of bronchitis is usually mixed with
enacious phlegm, difficult to expectorate.

The age, also, will assist the diagnosis, and where as
n phthisis, the visage is generally transparent and the
spirits elastic, in chronic bronchitis the visage is thick
i >r cloudy, and the temper irritable.

Chronic diarrhoea often accompanies phthisis, but the
everse is usually the case in chronic bronchitis.

1GG

THE LUNGS.

Phthisis and chronic bronchitis may, however, it
must be remembered, coexist in the same subject.

Allopathic treatment. — Occasional cupping, “ flying
blisters,” counter-irritation by croton oil, tartar emetic,
or turpentine, inhalations of tar-vapour, Iodine, Creo-
sote, and Chlorine. Internally — Ipecacuanha, Colchi-
cum, Hydrocyanic Acid, Squills, Ammoniacum, Opium,
Copaiba, Iodide of Potassium, Quinine and the
mineral acids, Sesqui-carbonate of Ammonia, &c.

The homoeopathic treatment of chronic bronchitis
will possess this advantage over the drugging system —
that besides the specific action of the remedies, the
vital forces of nature will never be weakened, a mani-
fest advantage in all cases of chronic disease arising
from general debility.

In bronchitis from heart disease, Lachesis, Cobra,
and Digitalis, will be useful. In syphilitic bronchitis.
Nitric Acid, Guaiacum, Aurum.

In emphysema. Ipecacuanha and Hyoscyamus, &c.

In gouty cases, Nux Yomica, Bryonia.

In green-sputa cases. Cannabis and Mercurius.

In cases in which the digestive organs are much dis-
turbed, Nux Yomica, Bryonia, and Pulsatilla, will be
useful.

In congestive cases. Phosphorus or Tartar Emetic.

Arsenicum will be one of the most useful remedies in
all cases of chronic bronchitis, and Sulphur in many
cases of long standing.

Hepar, Stramonium, and Baryta Carbonica are also
to be considered.

The inhalation of stimulating vapours, as of Ammonia
or Turpentine, will often be serviceable.

CHRONIC BRONCHITIS.

107

The inhalation of oxygen gas is often especially
useful in asphyxiating cases.

Manual frictions with camphorated oil, and various
stimulating liniments, will also frequently afford an
increase in vigour and comfort.

The air-bath, viz., the sitting in a chamber of con-
densed or attenuated air, will be useful in some cases of
chronic bronchitis, arising from relaxed bronchia, and
so also, in such cases, will the inhalation of oxygen be
often very invigorating.

The hot-air bath, by producing copious perspiration,
will afford immediate relief to the overcharged bron-
chial tubes.

Those who are liable to attacks of bronchitis will find
the unshaved beard a considerable protection and the
most natural of respirators.

Of all remedies for obstinate chronic bronchitis, a
change of air is the most truly homoeopathic and the
most successful.

No rule can be set down absolutely about the choice
of a climate, except the rule of present experience and
preference. But a balmy, yet mildly bracing and dry
climate will generally be the best, and mountain air,
if it can be got without risk of gusts of chilling wind ,
is especially serviceable in gouty cases, while a warm,
dry air, like that of Africa or Australia, may be prefer-
able in other cases.

But on the subject of climate I shall enter more fully
when considering climate in relation to phthisis.

As chronic bronchitis is frequently united with a
dyspeptic and gouty habit, the “ water cure ” will be a
great auxiliary to homoeopathic treatment.

Great attention to diet is very essential in chronic

168

TIIE LUNGS.

bronchitis ; the food must often be nourishing, but not
stimulating, and never loading. Water, I believe, is the
best beverage; but if stimulants are found advisable,
weak spirits and water, or claret, or vin-ordinaire, arc
to be preferred to malt liquors or strong wines. Fine
bitter beer in draught , and in moderation, may, in
certain cases, not be unadvisablc.

Gentle horse-exercise, in many cases, will be highly
beneficial, relieving local congestions and eliminating
accumulations of phlegm.

Many cases of chronic bronchitis are complicated
with congestion of the liver, foul tongue, deranged
digestion, and piles. Chronic bronchitis may induce
these symptoms, from long congestion and general
poisoning from insufficient oxydation of the blood.
Such cases, if they resist the ordinary homoeopathic
treatment, may often derive the greatest possible
benefit from a course of water treatment.

HAY ASTHMA.

Hay asthma is an affection which seizes on some
individuals during the hay season, and is caused, proba-
bly, by the pollen of the hay floating in the air.
London is surrounded on all sides by hay- fields, the
sweet smelling of which is often so strong as to be quite
perceptible in the densest parts of the town, especially
at night, the fires being out and the wind blowing from
the north.

Accordingly some individuals, especially among the
aristocracy, cannot stay in town during that season, but
are obliged to go to the seaside.

The symptoms are those of acute, sneezing catarrh.

INFLUENZA.

1G9

Allopathy recommends the shower-bath, tonics, and
Creosote and Chlorine inhalations.

Homoeopathists have often considerable success in
this disease by the administration of Arsenicum, Ipeca-
cuanha, Assafcetida, Nux Vomica, Lacliesis, Musk, and
Sulphur, or from the inhalation of Camphor or
ammoniacal vapours.

INFLUENZA.

Influenza , the Italian word, for “ influence/’ is an
epidemic catarrh, and appears to me to arise manifestly
from a certain poison existing in the air.

It is recorded of the chemist Berzelius, that he
suffered from symptoms exactly analogous to acute
catarrh from accidentally inhaling a bubble of seleniu-
retted hydrogen, and if such a gas could be applied
homceopathically, I believe it would be found to be a
valuable specific for this disease. Some years ago I
prepared a trituration of Silenium, and have occa-
sionally used it with good effect in catarrh, but
seleniuretted hydrogen would most probably be much
more effective.

Dr. T. Thompson has written the “ Annals of Influ-
enza ” in one of the volumes of the Sydenham Society ;
and the theories of its connection with telluric exhalations,
earthquakes, comets, volcanic eruptions, and ozone, are
discussed, but the inquiry fails to throw any light on
the subject.

It has for many years appeared to me to be not im-
probable that the influence is from certain atmospheres,
it may be, of exploded planets, which the earth in her
solar circuit occasionally passes through. To attribute

170

THE LUNGS.

catarrhs or influenza to mere change of temperature
has always appeared to me quite untenable. Cats, dogs,
and horses, are often affected in epidemics of influenza.

The symptoms are those of severe catarrh, accom-
panied with fever, rigors, bruised pains, sneezing, bron-
chial cough, sometimes intense headache, and sensations
as if poisoned, while extreme prostration of strength
generally accompanies the attack.

Treatment. — Acute influenza is, especially under what
is called active treatment, one of the most fatal diseases
among debilitated old people.'

Although it is almost incredible, yet there are physi-
cians who have recommended bloodletting in this
disease, and that although the disease is essentially one
of prostration of strength, as from an irritant poison.
“ The less active practitioners ” employ tonics and dia-
phoretics, &c.

Homoeopathy is decidedly successful in the treatment
of this disease.

Aconite, Nux Yomica, Bryonia, Phosphorus, Ipeca-
cuanha, Hyoscyamus, China and Veratrum, Camphor
and Sulphur, are all good remedies, but probably
Arsenicum is the most important of all our remedies in
this disease.

Camphorated Spirit is the best remedy in the inci-
pient stage ; Nux Yomica is one of the best remedies in
the congestive stage ; and Arsenicum in the sneezing,
or debilitated stage.

The patient should be kept in an equal and moderate
temperature, and fed on slops, or on beef tea and wine,
according to the condition of fever, or of depression.
The great danger from the disease, with old people, is
from the prostration of strength. In such cases,

IIOOPING-COUGII.

171

Arsenicum, from the 3d decimal to the 1.2th centesimal,
is the best remedy. Wine, or brandy and water, may
also be advisable.

HOOPING-COUGH.

Hooping, or whooping-cough is so named from the
sounds produced during the spasmodic cough, with its
succeeding spasmodic inhalations. It is essentially a
spasmodic disease, implicating the pneumogastric nerve,
generally accompanied by more or less bronchial flux,
and sometimes by congestion of the lungs and pneu-
monia.

It is divided into the catarrhal, spasmodic, and ter-
minal stages.

The catarrhal symptoms may last a few days, or even
weeks, accompanied by a short cough, sneezing, and
redness of the eyes, before the true hooping, spasmodic
cough appears. The spasmodic cough may be slight,
comparatively, or so violent that the head of the poor
child requires to be held, while blood may come from
the nose and mouth, or even from the eyes and ears.

A paroxysm consists generally in five or seven
violent coughs, by which the air is almost entirely
expelled from the lungs; this is immediately followed
by a long and painful inhalation, with more or less
spasm of the glottis, and a look, sometimes, of intense
anxiety on the part of the poor child, who appears
almost asphyxiated — the eyes starting from the head,
and the face deep red or purple ; and this may be
repeated three or four times, with almost equal distress
to the observer as to the little patient. Although,
however, the paroxysm is so intense as apparently to

172

THE LUNGS.

threaten the life of the child, yet immediately after it
is over the child may he quite cheerful and happy.

During the paroxysm the child often vomits, espe-
cially as paroxysms are apt to occur shortly after meals.

Paroxysms may occur only two or three times a day,
or almost every hour.

The disease may be so slight as to raise a doubt
whether it is hooping-cough or not, and yet this slight
attack would appear to afford ample protection against
all future infection from this disease. On the other
hand, the cough may last from a week or two to
eight months or even last until, or reappear after
twelve months from the occurrence of the first symp-
toms.

Any mental excitement is apt to bring on a paroxysm ;
and as the child is generally peevish, much kindness
and forbearance are necessary on the part of the
mother or nurse. Sometimes, after the disease may be
regarded as cured, a slight cough may occur nightly for
weeks, at the same hour — a singular manifestation of
periodicity, occurring as it does during sleep. Death
occurring in a paroxysm is an extremely rare result.
It has yet happened, and so also has rupture of the
air-cells and of the pleura.

Hooping-cough is certainly one of the most singular
diseases which afflict humanity, and as almost all
disease can be directly or indirectly traced to mis-
conduct on the part of man ; so perhaps it may be one
day discovered that hooping-cough and measles, when
they attack children, may arise from some error in
management. So far, however, as our present know-
ledge goes, this cannot be traced ; and all, with rare
exceptions, whether among the rich or the poor, the

HOOPING-COUGH.

173

carefully watched or tlie neglected, arc amenable to this
disease.

If, however, the child have a good constitution, and
be well treated, the disease is rarely very serious. It is
often very different with children of a scrofulous habit,
and with the lungs or the brain predisposed to weak-
ness. In such cases, tubercle often begins to be deve-
loped, and the little patient sooner or later falls a
victim to lung or brain disease.

Treatment. — The allopathic treatment is usually
mild ; but blisters, emetics, purgatives, Hydrocyanic
Acid, and “ Belladonna, pushed to the verge of
poisonous effects, is sometimes (says the allopathist) a
justifiable remedy.”

The homoeopathic treatment of this disease is not
only very successful, but it has this very manifest
advantage over allopathic treatment — that it never can
excite spasmodic pneumogastric action by the adminis-
tration of drugs repugnant to the taste and stomach of
the child, and this alone, in a negative point of view, is a
most material advantage, to begin with.

The remedies most used are Belladonna, Bryonia,
Nux Vomica, Ipecacuanha, Ant. Tart., Chamo-
milla, and Ilyoscyamus. Bismuth, Drosera, Arnica,
Arsenic, Hepar Sulph., Cina, Sulphur, and Carbo
Veg., are also enumerated.

In very mild weather, when there is no wind, the
child should, as a rule, go out daily, in all ordinary
cases. But in cold, or windy weather, the child must
be kept in the house, and it will be found a great
advantage to have two nurseries, and change the room
several times a day, the rooms being alternately

174

THE LUNGS.

ventilated by the windows of the one room being
opened when the children are in the other, a fire
being kept burning in each room, if the weather is
cold or damp.

Should the disease become chronic, no remedy is
equal to a change of air — sea-air, for those who live in
inland places, being best.

The food must be very simple, and generally very
little animal food should be given. The food given
should be small in bulk, and not hot.

Frictions with oil, or oil and Ammonia, down the
sides of the spine, will do good in severe cases, and also
in debilitated conditions resulting from the disease.

It is a happy coincidence when the disease appears in
mild weather instead of in winter or spring ; and in
cases where there is a likelihood of danger from the
delicacy of the child, it might sometimes be advisable
to remove at once to a mild locality on the first appear-
ance of the disease.

Hooping-cough is pre-eminently contagious, and if it
once show itself in one child, there is little need to
remove the others who may have been in the same
room, although only for an hour ; and yet, strange
to say, Laennec writes, “ There is scarcely any proof
that the disease is contagious.” The disease has been
known to be contagious, although no hoop has been
heard ; but it would appear not to be contagious after
the disease has fully, and for some time, declined, even
although an occasional hoop may still be heard.

ASTHMA.

Asthma (acrO/ua), or dyspnoea, signifies difficult breath-
ing ; and this may arise from either organic or spas-

ASTIIMA.

175

modic causes. It may arise from corpulency, from
hysteria, enlarged bronchial glands, or from phthisis;
from -weakness of the heart, viz., insufficient circulation;
from the reverse, viz., hypertrophy of the right ventricle,
causing congestion of the lungs ; from valvular disease,
and especially tricuspid regurgitation, resulting in in-
sufficient blood being driven through the lungs; from
emphysema, impeding the circulation through the lungs
and diminishing the amount of oxygen taken up by the
capillaries ; from chronic bronchitis, acting in like man-
ner ; from thoracic effusions, with emphysema, or from
a tendency to lung congestions (mere plethora may
sometimes be a cause) ; from “ anaemia,” or deficiency
of redness, that is, deficiency of oxygen, in the blood ;
from tumors pressing on main bronchi. Deficient con-
tractile pow'er of the muscular tissue of the bronchia is
said to be occasionally a cause, but the chief cause of
chronic spasmodic asthma is the occurrence of spasm in
the muscular tissue of the bronchia. Spasm of the bron-
chial muscular tissue is much under the influence of the
pneumogastric nerves, that is, under the influences of
the brain, spinal cord, stomach, liver, bowels, or uterus.
Hence a paroxysm may arise from flatulence, indiges-
tion, the inhalation of cold air, mental irritation, or
uterine disturbance, &c.

In spasmodic asthma, a paroxysm may last from half
an hour to twro or three hours. It may come on with-
out any assignable cause, as during sleep, awaking the
patient, who, with much alarm, may start out of bed
and rush to the open window. lie elevates his shoul-
ders and laboriously draws in his breath, which refuses
to enter, except slowly and with a wheezing sound. In
severe cases, the face is flushed or livid, the eyes promi-

176

THE LUNGS.

nent and suffused, and the face expressive of anxiety
and terror, while the skin gets cold and clammy.

After the paroxysm there often succeeds a sensation
of exhaustion ; but many individuals enjoy perfect health
in the intervals between the paroxysms.

Spasmodic asthma, with emphysema or chronic bron-
chitis, may lead to hypertrophy of the right ventricle,
owing to the struggle the heart has to drive the blood
through the lungs ; this hypertrophy may lead to tri-
cuspid insufficiency, swelling of the auricles may suc-
ceed, and, with chronic bronchial flux, terminate in
general dropsy.

In children, asthma may be mistaken for croup, but
'thg; disease is comparatively rare in the young.

The popular belief in the longevity of those affected
with spasmodic asthma is often ill-founded, but it may
in part be true, as a longevity conspicuous in contrast
to the apparently extreme weakness of the individual
afflicted. It may, however, have some further founda-
tion in the fact of the asthmatical taking great care of
themselves, and generally indulging in the constraint of
all the appetites. Also, perhaps, because the asthmatic
lives a life analogous to that of the reptilia, viz., a life
of slow oxydation.

Some asthmatical individuals are much better in win-
ter than in summer, the action of the sun's rays of light
or of heat being apparently an injurious excitant.

TREATMENT.

Allopathic treatment. — “ If there be great congestion,
bloodletting may be advisable." Nauseating expecto-
rants, Lobelia, Squill, Ipecacuanha, Colchicum if the

Tit KAT.UK NT.

177

patient is gouty, Sul. Zinc emetics, Ether, Assafcetida,
Musk, strong Coffea, Stannum, Cannabis Indica, Bella-
donna, Opium ; fumes of burnt brown paper saturated
with nitre ; galvanism, making the current between the
neck and the epigastrium ; cold dash of water ; feet in
hot water and mustard. Chloroform inhalations, ciga-
rettes of Stramonium ; Strychnia, and spinal counter-
irritation, &c.

Homoeopathic treatment will possess advantages over the
above treatment, in such cases especially as are compli-
cated with constipation and dyspepsia, as by the use of Nux
Vomica ; and also in the homoeopathic use of such of our
medicines as are more or less specific to congestions
and fluxes in the lungs, as with Bryonia, Aconite, Phos-
phorus, Ipecacuanha, Arsenicum, or Tartar Emetic.

With regard to purely spasmodic asthma, Nux Vo .
mica in dilutions, from the 3° decimal to the 30° cente-
simal, will be generally found more useful than any
other medicine, given in doses repeated every quarter
of an hour during a paroxysm.

The other remedies to be considered are Belladonna,
Sambucus, Mosclius, Lachesis, Sulphur, Stramonium,
Stannum, &c.

The cold water dash, vomiting caused by tickling the
fauces, a cup of strong coffee, may be employed some-
times as palliatives, but can have no claim to the title
of curative agents.

Frictions over the spine with oil, or oil and brandy,
or camphorated oil, may afford much relief.

Air-baths, of compressed or partially exhausted air,
are truly homoeopathic in their action, and the former
is employed at Benrydding with good results. So also is
the popular remedy of burning brown paper and in-

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THE LUNGS.

haling the fumes truly homoeopathic, and worthy of
trial. Inhalation of the vapour of camphor may also be
refreshing.

The treatment of difficult breathing from heart dis-
ease, and from chronic bronchitis and humoral asthma,
have come under consideration elsewhere.

Cases which derive benefit by removing from the
country to London, or by removing from the suburbs
into the centre of the town, are most probably cases
illustrating the homoeopathic action of carbonic acid gas
or sulphurous vapours ; although they may merely be
examples of the action of change of air.

On the other hand, cases benefited by removal to the
country are more likely to be examples of hygienic
action.

The food of the asthmatical must be carefully se-
lected, sparing in bulk, and eaten slowly. It should be
unstimulating, non-flatulent, and not taken too hot.
However, hot draughts of tea, coffee, or gin and water,
as expedients, often give immediate relief ; but are as
much as possible to be avoided, as tending to aggravate
the disease itself, and to lead to habits which may be
otherwise injurious.

The hot air bath, as an anti-spasmodic in dry asthma,
and as a derivative to the skin in asthma complicated
with excessive bronchial secretions, is likely to be often
beneficial.

ACUTE PLEURISY.

Acute pleurisy is an inflammation arising in the sub-
serous pleural tissue, producing congestion of the minute
vessels, generally or in patches, and followed by
thickening or opacity from fibrinous exudation ; which

ACUTE PLEURISY.

17(J

exudation may become reabsorbed, or may remain for
weeks, for months, or permanently, as an indurated
and rough surface producing friction sounds.

During the inflammatory process effusion takes place,
chiefly sero-alburainous ; but it maybe sero-sanguinary,
or sero- purulent.

Pleurisy passes through four stages. 1st. The dry
stage, when there exists vascularity, and loss of polish
on the pleural surfaces, producing grazing friction
sounds. 2d. Fibrinous exudation stage, with increased
friction. 3d. Effusion of serum, with or without pus,
blood, or flocculent matter. This effusion gravitates to
the base of the lungs, or, if abundant, rises to the top
of the pleural cavity. 4th stage. Absorption of this
fluid and complete recovery, or, it may be, a permanent
rough exudation remains behind, with more or less
condensation of the lung tissue, especially at the base.
If the lung has been long compressed by the effusion,
it may have lost its elasticity, or become bound down
by bands of fibrin, and remain permanently more or
less contracted and airless, the chest-walls ultimately
sinking inwards, in accommodation to the size of the
lung. In such a case, vesicular breathing has dis-
appeared, and the percussion-sounds are hard and dead,
except over the large bronchi, where the percussion
may be tubular.

If this result has happened at the base of the lung
only, the respiration sounds are exaggerated at the
upper part of the same lung ; or if it have happened
over the entire of one lung, then the other lung will
yield exaggerated respiration sounds.

A compressed lung being in an abnormal condition,
repeated sub-acute pleuritic attacks are apt to re-occur

180

THE LUNGS.

and tlie lung is prone to become the seat of tubercle.
The general health, in cases of locally collapsed lung,
even under the least unfavorable circumstances, is below
par, and there readily occur fits of dyspnoea, yet there
may be a considerable amount of fair average health.

In cachectic subjects, and those who have a cancerous
or tubercular diathesis, or in whom there is Bright’s
disease, the absorption stage may become a stage of
chronic purulent effusion, and lead to chronic abscesses
and fistulous openings. Such a result is, however,
happily of extremely rare occurrence, comparatively, as
a Sequel to acute pleurisy.

During the first, or vascular stage, the respiration,
owing to the pain produced, is subdued or jerking ;
percussion yields no perceptible dulness, but grazing
friction sounds may be heard.

During the second, or exudation stage, the signs are
much as in the first stage, the friction-sounds being
coarser.

During the third, or effusion stage, all friction and
respiratory sounds disappear as high as the level of the
fluid effused ; but above this line, friction may be heard,
with exaggerated respiration sounds. If the effusion
be great, there may be bulging of the affected side,
great displacement of the heart, even across the medias-
tinum, or displacement of the liver or spleen, and even
the apex of the lung may be carried abnormally upwards
behind the clavicle. In this stage, fluctuation may be
detected.

Effusion within three hours of the first symptoms of
the attack of inflammation has been known to be so
copious as to cause bulging.

In the stage of absorption, the bulging gradually

ACUTE PLEURISY.

181

subsides, friction sounds reappear, and cegopliony may
be heard. Percussion-sounds recover their clearness,
although a certain amount of local dulness may remain
for months, or even permanently, from consolidation or
fibrinous deposits. The respiration sounds also re-
appear, but are at first weak or harsh, and may be
bronchial or blowing for months.

Pleurisy is generally induced by getting cold and wet,
or by walking on damp or cold pavements with thin
boots, or from exposure, in spring, to the east wind, or
exposure on returning from crowded meetings, churches,
or bfllls ; or going to assemblies and shivering in thin
low dresses, being accustomed to be over-caudled and
clothed at other times. This last is a cause, especially,
with little children at Christmas parties.

Pleurisy may follow scarlet or typhus fever, or
measles, and is apt to show itself in BrighPs disease,
cancer, heart disease, and often locally at the region of
tubercular deposits.

The Symptoms of Acute Pleurisy. — The first symptom
is usually “ a stitch in the side,” with rigors. The
stitch is usually situated at the anterior or posterior
base of the lung. The pain may be intensely acute, or
there may be a mere sense of uneasiness; and the
aggravation of the pain is no measure of the extent of
the inflammation, or the amount of the effusion.
Indeed, there may be no stitch, and yet great effusion ;
and there may be acute pain, and yet little or no effu-
sion, the pains being, it is supposed, chiefly from inter-
costal neuralgia ; an explanation the more probable,
when it is known that the stitch may occur in the oppo-
site side to the one where the pleurisy exists.

18.2

THE LUNGS.

The breathing, if there be pain and active inflamma-
tion, is short and frequent, and there is dyspnoea.

A short cough is a very general accompaniment of
pleurisy ; but the cough may be entirely absent ; and it
is important to remember this, as pleurisy may easily
be overlooked if there be no cough and but little pain
in the side, and the patient, being neglected, may still
further expose himself, until very serious symptoms are
developed. Indeed, all the symptoms of pleurisy may
be latent, until dyspnoea shows itself, caused by the
amount of effusion.

During the early stage, the patient usually prefers
lying on his sound side; but after effusion has taken
place, especially if copious, he prefers lying on his back,
with the head raised.

The pulse, in acute pleurisy, is usually quick and
hard ; the urine, deep-coloured and scanty.

Inflammation in the pericardium and peritoneum
may arise from the acute pleuritic inflammation extend-
ing to these serous membranes.

In chronic pleurisy, and in the event of the exuda-
tion becoming purulent, perforation has occurred from
the pleura into a bronchus, and muco-pus has been
expectorated. It is also said that, without perforation,
what is called “ metastatic flux ” has taken place, and
as much as two pints been at once voided from the
lungs, and yet not from a cavity, but from the bronchial
tubes only.

In purulent pleurisy gas may be generated, and the
upper part of the lung yield tympanitic percussion.

In chronic pleurisy the affected side may become
cedematous, and the face puffy. “The opposite lung
may become liypertrophous and emphysematous.”

DIAGNOSIS OF ACUTE AND CHRONIC PLEURISY. 183

In purulent pleurisy the pulse and the skin show
hectic symptoms. There is general wasting, and the
result, which is in the majority of cases fatal, is often
hastened by Bright’s disease.

In cases not terminating fatally, the pus may become
absorbed, or be discharged by external fistulae.

Chronic pleurisy is chiefly found in cases where there
is a cachectic condition from cancer, tubercle, syphilis,
or excess.

Acute pleurisy is much more common in men than in
women, and fatal chronic pleurisy occurs in males in
the ratio of five men to one female ; partly because
men are much more exposed to cold and wet, and the
disease is more apt to be complicated with Bright’s
disease in men, from habits of intemperance.

Circumscribed pleurisy may occur, owing to plastic
adhesions confining the effusion to one district. The
upper, middle, lower, and even, theoretically, the
mediastinal surface of the pleura may be the seat of
such localised effusions ; and, in such cases, the disease
may be mistaken for abscess, tumor, or local pneu-
monia.

DIAGNOSIS OF ACUTE AND CHRONIC PLEURISY.

Pleurodynia or intercostal neuralgia with cough may
simulate pleurisy in the dry stage.

Peritoneal friction, or pericardial friction sounds
may also mislead into the belief in pleural friction.

Pneumonic consolidation may simulate pleurisy, but
the sputa is different, and in effusion there is no local
fremitus, and no crepitant rhonchi, but often tubular
percussion sound under the clavicle, and bulging of the

184

THE LUNGS.

affected side. If there be fluid, its exact locality will
be altered with the position of the patient.

Enlargement of the liver upwards is distinguished
from effusion by the liver being depressed on full inspi-
ration, a result which cannot happen with effusion, and
so also with regard to enlarged spleen.

Tubercular dulness, as a rule, proceeds from above
downwards, pleuritic effusion from below upwards.

In cases of dull percussion from consolidated lung
from pleuritic effusion, the history of the case, together
with the aspect of the patient, and the dulness being
chiefly at the base, will distinguish it from tubercular,
cancerous, or pneumonic consolidation.

Pulsating Empyema. — A circumscribed collection of
pus in the pleura, arising from pleurisy, may pulsate,
owing to the fluctuating movement given to it by the
beating of the heart, and such pulsations may give
rise to the suspicion of aneurism. The absence of
aneurismal murmur or thrill, and the want of signs of
concentric pressure, and the history of the case, will
guide the observer.

Pectoriloquy and cavernous breathing may be heard
from the lung being condensed by pressure (from a
former pleurisy) over an enlarged bronchus ; and from
the general cachexia the diagnosis may be (erroneously)
“ tubercular cavity,” the history of the case and the
absence of signs of tubercle at the apices, will aid the
diagnosis, but if tubercle at the apices coexist with
pectoriloquy, especially if percussion over the pectorilo-
quous region be dull, and there be hectic, the diagnosis
may be very uncertain.

The allopathic treatment of acute pleurisy, if the

TREATMENT OF PLEURISY.

185

patient be robust, consists in bleeding, cupping, leech-
ing, salivation, blisters and purgatives, &c. “ Cover the

patient's side with a blister, there is no use of trifling !"
is the advice once given me by one of my former
teachers, a distinguished London chest doctor.

A certain Frenchman, M. Gendriu, was wont, in the
acute stage of effusion, uniformly to practise perforation
of the pleura to draw off the water, until he Mas
forced to desist from the constant death of his patients,"
so writes Dr. Walshe, p. 378, and may we not ask why
was M. Gendrin not indicted for manslaughter?

Dr. Harper, of Windsor, appears to have been
more successful, for in a very interesting paper which
he read before the British Homoeopathic Society,
April, 1859, he gave the history of a case of acute
pleurisy, in a lady, set. thirty-two, threatened with
instant suffocation, in which he performed paracentesis,
and drew off half a gallon of water to the immediate
relief of the patient, who made a complete recovery,
and certainly under such circumstances this hazardous
operation would appear to be necessary. Dr. Harper
allowed the fluid to escape only during inspiration, when
the lungs being distended as far as possible, hindered
the entrance of air into the pleural cavity.

The homoeopathic treatment of acute pleurisy is per-
fectly simple. During the inflammatory stage Aconite
and Bryonia in alternation, the 3 decimal dilution of
the tincture, a tea-spoonful of medicine, every half-
hour, one, two, or three hours, according to the intensity
of the symptoms. In the first stage many would prefer
the use of Aconite only ; Bryonia being used after
effusion has taken place. Belladonna may be used to
relieve the neuralgic pains. Arsenieum is also one of

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THE LUNGS.

our best remedies in aid of the subsequent absorption
process, and Sulphur is also given in this stage.

Acute pleurisy, although it may lead to chronic pleu-
risy and thus destroy life, is yet, in a purely idiopathic
form, a disease not often fatal, even under allopathic
treatment, unless bloodletting has been pushed to ex-
tremities, as no doubt in former days, especially, was
often done. Dr. Walshe says he has never lost a case
of pure idiopathic pleurisy, but if this be the case a large
number of pleurisies must be complicated, because of
all pleurisies treated at the general Hospitals of Vienna,
the proportion of mortality was from twelve to thirteen
per cent., the mortality at the Homoeopathic Hospitals
in the same city, being about one and a half per cent. (See
further, Professor Henderson’s f Reply to Dr. Simpson/

pp. 80, 81.)

I fully believe that under homoeopathic treatment
chronic pleurisy must be, as compared with what happens
under the monstrous allopathic treatment, as narrated
above, a very rare sequence to acute pleurisy.

That heroic treatment fails to kill in acute idiopathic
pleurisy, only proves that the disease is not one of those
which seriously affects a vital organ. It is not for
instance like pneumonia, which implicates the substance
of the lungs, but effusion is rather a mere mechanical
pressure external to the lungs, and so long as this pres-
sure is not so extensive as to threaten suffocation, the
result is more inconvenient than dangerous.

The treatment of chronic pleurisy. — The result in
this disease may be — 1 . Collapse of the lung, and retro-
cession of the chest walls ; or, 2. There may be perma-
nent purulent secretion ; or, 3. There may be fistulous

CH ICONIC PLEURISY.

187

openings through the pleura, or even through the chest
walls, which discharge pus.

In the first instance, little treatment maybe required,
as the sound lung learns to perform double work, and it
is oidy necessary to treat such attacks of pain or
pseudo-pleurisy, &c., as may arise in the injured lung,
and to attend to the general health.

In the treatment of empyema, or pus in the pleura!
cavity, allopathy says, “ General bleeding may, with
caution, be had recourse to •/’ Iodine, also, rubbed in,
“ blisters are often signally beneficial.” “ Issues,
setons, moxus, and the actual cautery may be tried.”

Who, after this treatment, which is taken from the
most “ scientific ” work of one of the most “ legiti-
mate” physicians of the present day, will assert that
the barbarisms of old physic are extinct ?

Homoeopathy, instead of bleeding, blistering, and
burning, will try the action chiefly of Silicea, Hepar S.,
Phosphorus, and Sulphur, for the cure of chronic
pleurisy, with secretions of pus, together with Cod-
Liver Oil, habitual manual frictions over the diseased
side of the chest, with oil and spirits, abundance of
fresh air, carriage or horse, or easy walking exercise,
and a diet such as can be perfectly digested, if possible,
as nothing will more hinder the re-absorption of fluids,
or more encourage diseased secretions, than any strain
laid on the digestive organs, or any extra labour put on
the excretory organs.

Empyema [tv, within, and ttvov, pus,) is an ancient
term, signifying collections of pus anywhere ; and
Laennec used it in reference to that collection of pus or
serum in the pleura which succeeds acute or chronic
pleurisy, and threatens to remain unabsorbed. It is

188

THE LUNGS.

evident that neither the bulging which is thus caused, nor
any other sign, can enable us to decide whether the fluid
is pus or serum.

Paracentesis has occasionally been successfully em-
ployed in drawing off this muco-pus or serum of
chronic pleurisy, but the result is more generally the
admission of air to the pleural cavity, and the conver-
sion of more or less laudible pus into a pus more or
less the reverse ; and this is followed by increased
hectic, and probably an accelerated fatal termination.
Further, as empyema is frequently accompanied by
tubercle in the lungs, the benefit to be derived from the
operation is still further problematical. Paracentesis
being an operation which is much shunned, it is possi-
ble that the results might be more favorable if it were
performed earlier in the disease than usual, and not
delayed until the stamina of the patient was exhausted.

The trochar is the best instrument to use, and the
space between the fifth and sixth ribs the best, gene-
rally, for the puncture, which, however, should be made
where the pus is most abundant, taking care to avoid
penetrating the diaphragm, and also the lung itself.
Total dulness, and the absence of all respiratory
murmur, will prove that the lung is not in contact with
the costal pleura. An exploring groove needle may be
passed before inserting the trochar, if doubts exist as to
the presence of fluid in contact with the costal pleura.

In order to prevent the entrance of air, it may be
advisable to perform the operation under water, or at
least to perform the operation so that the gravitation of
the fluid may cover the internal orifice. Why should
the fluid not be drawn off by the aid of a suction
pump ?

PNEUMOTHORAX.

189

HXDROTHORAX.

Hydrothorax is tlic term given to accumulations of
water in the chest from causes other than idiopathic
pleurisy, as from the presence of tumors from tuber-
cular or cancerous disease, or Bright’s disease, but most
frequently this dropsy results from heart disease.

There is lividity of face and dyspnoea, and, if suffo-
cation threaten, paracentesis has been resorted to with
temporary relief.

Allopathy recommends cupping and blistering, but
the presence of hydrothorax being almost synonymous
with a broken constitution, it is not easy to recognise
the good anticipated from such depletory measures.

The liomceopathist will endeavour to relieve the
symptoms by Veratrum and Lachesis, but chiefly by
Arsenicum.

Frictions, also, over the back and chest will give
relief, and as pure and elastic an atmosphere as can be
secured will be sought after. The treatment, in short,
will be as for effusion in heart disease.

PNEUMOTHORAX.

Pneumothorax is an accumulation of gas in the
pleura, the result, it may be, of external wounds
opening into that cavity, or of gangrene, or of tuber-
cular or emphysematous perforation from the lungs, or
it may be from the result of decomposition taking place
in empyema.

As gas often rapidly forms in the intestines, and
occasionally even in the cellular tissue of hysterical
women, there is no physiological reason why it may not
sometimes arise idiopathicaliy in the pleural cavity,

190

THE LUNGS.

although there is no proof that such an occurrence has
happened. Be that as it may, certainly pneumothorax
is, in the great majority of cases, the result of phthisical
perforation.

The symptoms of perforation having taken place are
generally a sudden and most acute pain, and a sensa-
tion of rupture, followed immediately by distressing
dyspnoea; but minute perforation may take place and
air enter so gradually that dyspnoea may be the first
symptom.

The presence of air in the pleura will prevent the full
expansion of the lungs. Acting like the irritation of a
foreign body, a secretion of fluid takes place, and
hydro-pneumothorax becomes established, followed by
symptoms of hectic and cachexia.

Death usually results in phthisical cases in from a
few hours to ten weeks ; but if the accident be in one
lung only, and the individual possess the free use of the
other lung, life may be long retained, or closure of the
perforation and recovery may take place.

Bulging takes place with tympanitic percussion, and
respiration sounds cease to be heard unless the layer of
air between the lungs and the walls of the chest be
very thin.

If effusion coexist with air, the lower part of the
lung yields dead percussion. By succussion, the splash-
ing of fluid may be heard, and cough sounds may echo
in the air cavity.

Allopathic treatment recommends bleeding, because
more fluid is in the circulation than the diminished
capacity of the lungs can oxygenate ; but the blood of
those wasted by phthisis is reconciled, as it were, to
defective oxygenation, and all the poor patient’s remain-

ACUTE PNEUMONIA.

191

ing strength is required to enable him, if possible, to
recover.

Lachesis and Arsenicum may afford some relief ; while
comfort will also, most probably, be obtained from
bandaging the chest by way of counter-pressure to that
from within.

Paracentesis performed below water may be some-
times thought advisable.

HEMOTHORAX.

Hcemothorax, or the effusion of blood into the pleura,
may be the result of wounds, fractured ribs, ruptured
aneurism, pulmonary apoplexy, cancer, or scorbutus.

In such cases there must be dull percussion, and diffi-
cult breathing.

It will be generally distinguished from pleuritic
effusion by its suddenness, the aggravated nature of
the symptoms, and the absence of friction sounds.

Army surgeons often meet with haemothorax, and para-
centesis has sometimes been practised with good results.

Civilians less frequently meet with the disease, and
then it is chiefly in cases which from their nature
generally terminate fatally.

ACUTE PNEUMONIA.

Acute pneumonia ( Trvevfjiojv , the lung), more cor-
rectly pneumonitis, is inflammation of the lungs —
that is, of the vascular system of the minute tubes
and air-cells. Like most other inflammations, it
generally results from exposure to cold or wet ; it has
besides resulted from over-straining the lungs in blow-
ing wind instruments, and from blows, &c. Three
stages are recognised in this disease. 1. The stage

192

THE LUNGS.

of engorgement. 2. The stage of red hepatization.
3. The stage of grey hepatization, or purulent infiltra-
tion, from the deposit of pus or exudation matter during
the softening of the plastic lymph of the red hepatiza-
tion.

In the stage of engorgement there is yet sufficient
air admitted to the lungs to float them in water, and
to cause crepitation on pressure. If cut, they exude
a red frothy fluid. In the stage of red hepatization
the lung is of the density of liver, sinking in water,
while the weight of the entire lung may be six times
that of the healthy lung, the air-cells being filled with
blood and fibrine, giving a granular aspect to the lung
when cut into.

If pneumonia supervene on old standing wasting dis-
ease, the texture of the lung is often friable and
pulpy, spleen-like ; but, if the attack seize lungs pre-
viously healthy, the texture is firm and liver-like, and,
on being cut into, exudes a claret-coloured fluid, viz.,
exuded broken down blood as it were, and containing
very few air-bubbles.

In the suppurative stage the lung becomes mottled,
with intersticial deposits of pus, giving the appearance
of grey or red granite, or a general straw colour, if the
suppuration be profuse.

These three stages may occasionally coexist in one
lung at different parts.

Abscesses may occur, chiefly in the old and decayed,
or those much exposed or debilitated by “ over treat-
ment.” These abscesses may be from the size of a
nut to that of an orange, and may rupture into the
pleura and cause death, or be voided, and the walls
healed by cicatrization. In an average of seven cases, it

ACUTE PNEUMONIA.

193

is estimated that the right lung will be exclusively
attached in four cases, the left lung exclusively in two
cases, both lungs simultaneously in one case. Again,
by averaging seven cases the upper and lower parts
of the lung will be each attached in three cases ; he
middle part in one case. Double pneumonia is much
more rare under homoeopathic than under heroic treat-
ment, proving that such heroic treatment tends to ex-
tend the disease.

Physical Signs. — In the preliminary stage of conges-
tion there may be no perceptible sign, except weak
breathing, probably from a certain soft tumescence in
the lungs, or harsh breathing from dry vascular injec-
tion.

In the stage of engorgement there is dull percussion.
The respiration is weak or rhonchal in the affected
parts, and exaggerated in the neighbourhood of these
parts.

The true crepitant liair-friction rlionchus of the
engorgement stage of pneumonia may escape detection,
owing to the rapidity with which the engorgement
stage has passed, giving place to the fibrinous exuda-
tion stage, by which the entrance of air is prevented
into the injected part.

If the hepatization be not so extensive as to block up
the bronchia, increased vocal vibration will be detected
somewhat in the ratio of the density of the solidifica-
tion.

Percussion is of various degrees of dulness, but it
may be the reverse, if the solidification bring into
communication a large bronchus and the chest
walls.

194

THE LUNGS.

Bronchophony will he heard under the same cir-
cumstances.

The respiration in hepatization ceases to he vesicular,
and becomes tubular over the region thus solidified,
but crepitating rhonchus may be heard at the same time
in the immediate neighbourhood.

There may be a purulent or other copious secretion
into the bronchia, causing bubbling rhonchi; and a
main bronchus may become temporarily occluded, ac-
companied for the time by a cessation of respiratory
sounds.

When resolution begins to take place after hepatiza-
tion, the blowing tubular breathing becomes softer and
softer. Crepitant rhonchi somewhat coarser than those
produced during the invasion of the disease reappear,
and the dulness on percussion gradually diminishes.
Thus, in from four to eight days, the lung sounds may
be again quite normal.

Instead of resolution occurring, accompanied by an
infiltrating* form of suppuration, there may, especially
in depraved constitutions, occur diffuse suppuration, a
very fatal result, or abscesses are formed, yielding dull
percussion ; and when the pus is discharged, should the
patient survive, the cavity may continue for some
time, viz., from a few days to three months, or even six
months, as in a case recorded by Laennec, to yield
cracked pot percussion and cavernous percussion, but
such cavities are generally soon closed by cicatrization *

Symptoms. — Like other inflammations, pneumonia is
ushered in with fever and rigors. The skin may be dry
and acrid. The breathing is short and rapid. There
may be fifty respirations in a minute, although the pulse

ACUTE PNEUMONIA.

195

may be only 100. The face is flushed, and the expres-
sion anxious. There is generally a dull pain in the
affected part, and there may be headache and vomiting.
Typhoid symptoms, in some cases, are so strongly
marked that the disease may be mistaken for typhus
fever. The pulse may range from 100 to 160, but may
be as low as 60.

The cough, at first, is dry and hard ; but usually
within forty -eight hours it is accompanied by a viscid,
rusty, or bloody sputa, of an adhesive, fibrinous nature,
and lasting from one to fourteen days, and in recovery
gradually becoming less and less bloody, and passing
through shades of brown and yellow until it becomes
white and bronchitic.

In rare cases, the sputa has not been bloody, and
cases occiu* without any expectoration whatever.

If there be true luemoptysis, as distinct from bloody
sputa, according to Dr. Walske, the case is complicated
with tubercle.

The sputa is fibrinous in quality ; and under the
microscope, blood-discs, oil-globules, and casts of the
minute bronchia may be discovered, but rarely true pus
cells. In the third stage, the expectoration is more or
less purulent.

Sugar sometimes exists in the sputa, owing, it is
believed, to the deficient oxydising process, from the
impervious condition of the lungs.

Probably from a like cause, there is sometimes a
considerable accumulation of fat takes place in the lung-
tissue during pneumonia; and often, from the same
cause, the expired air, even during tlie fever, may be
colder than natural.

Owing to hepatic obstruction, the right side of tlie

196

THE LUNGS.

heart and the jugulars may become gorged with blood,
and the blood being highly fibrinous there is a ten-
dency to the formation of coagula in the right side of
the heart. The tongue may, or may not, be brown and
coated.

If the attack exist in the lower part of the right lung,
the liver may become affected, and jaundice follow.

The urine is scanty and acid, but convalescence is
sometimes ushered in by a plentiful flow from the
kidneys.

“ The anatomical terminations of acute pneumonia
are — by resolution — or by diffuse suppuration, by
abscess, gangrene, or chronic induration ; the clinical
terminations are by recovery, death, or lapse into the
chronic state.”

Resolution, or melting, as it may be called, may take
place in the engorgement stage, but usually in the hepa-
tized stage, and generally begins from above down-
wards. Should the reverse take place, and the apices
be the latest to become sonorous under percussion, a
suspicion of tubercles in that quarter may be enter-
tained.

Resolution wrould appear to take place, under homoeo-
pathic treatment, in a larger proportion of cases before
hepatization has occurred, than happens under blood-
letting, &c.

The lung is cleared of the fibrinous deposits partly
by absorption, and partly by expectoration.

There may be no positive or exclusive sign or symp-
tom of the formation of abscesses in the affected lung.
Such a result rarely occurs, except in broken-down
constitutions, when rigors, sordes, hectic and typhoid
symptoms may also be expected.

ACUTE PNEUMONIA.

197

Iii the old and debilitated, latent pneumonia may
occur ; the only symptom being rapid breathing.

Professor Henderson showed, twenty years ago, that
pneumonia tended spontaneously to cut itself short by
hepatization, debarring the further entrance of blood
at the inflamed part of the lung.

Resolution consists in the gradual softening and
disintegration of the hepatoid substance, and is fol-
lowed by the expectoration of sputa, which are at first
bloody, and fibrinous, and mottled, and terminate gra-
dually in frothy, colourless mucus.

Diffuse, or profuse, or destructive suppuration, on the
contrary, usually indicates great depravity of constitu-
tion, and is usually fatal. It is not, however, unlikely
that these results are sometimes produced by bad
treatment.

The average duration of the disease, under allo-
pathic treatment, is about thirty days; the average
duration, under homoeopathic treatment, is only twelve
days.

Convalescence is generally more rapid than might be
anticipated from so severe a form of disease ; but a
certain amount of debility, pain in the chest, shortness
of breath, and dulness on percussion, continue for some
time, together with a tendency to renewed inflam-
matory attacks in the lungs, demanding carefulness,
especially in severe or changeable weather. Suppuration
may take place in the inter-lobular tissue, or such
tissue may become the seat of fibrinous induration
matter, leading to contraction of the lung tissue,
enlargement of the bronchia, and more or less imper-
meable and dense lung tissue, with weak or tubular
breathing.

198

THE LUNGS.

Diagnosis. — Pneumonia will he distinguished from
capillary bronchitis by crepitant rhonchi being generally
local, while the sub-crepitant rhonchi of capillary bron-
chitis is usually pretty general in both lungs. Localised
dull percussion is a further distinctive sign in favour
of pneumonia. The dull percussion from pleurisy is
almost always to be found at the base : it is more
absolute dulness than that of pneumonia, and no crepi-
tation is heard. The pleuritic dulness is often also
altered by the position of the patient. The “ rusty
sputa ” of pneumonia, with the physical signs, are,
however, usually unmistakeable.

Results and Treatment . — Under the allopathic treat-
ment of M. Grisolle, as quoted by Dr. Walshe, “ Of
103 convalescents from pneumonia discharged from
the hospital between the twentieth and fifty-fifth days
of the disease, 37 had no morbid signs remaining,
36 had weak respiration, 14 slightly blowing respira-
tion, 11 redux- crepitant, or sub-crepitant rhonchi, and
5 deficient expansion, with bronchitic rhonchi.” That
is, about two thirds of those discharged as convalescents
went out with slight morbid symptoms remaining, the
greater proportion of which number would probably
attain to perfect health.

Death, when it occurs, is usually in the liepatoid
stage, and proceeds from gradual asphyxia, viz., defi-
ciency of oxygen, and loss of vital power ; but as death
often results under allopathic treatment when only
the third of one lung is liepatised, it seems difficult to
resist the conclusion that such cases are chiefly killed
by treatment.

Andral says that recovery is the exception, should
the respirations exceed fifty in a minute. But it is to

ACUTE PNEUMONIA.

199

be remembered, that in the hysterical the respirations
may be as frequent with or without inflammation of
the lungs, and with no real danger. It is further to
be remembered that this is the experience of heroic
treatment.

Age is an important element in the rate of mortality.
The most fatal cases are those in new-born infants. In
them pneumonia is generally double, that is, affects both
lungs, but is usually lobular, that is, with interspaces of
sound lung. Pneumonia in very young children is
also a dangerous disease, because it usually supervenes
on some other disease, as measles, hooping-cough, croup.

Pneumonia in infants, according to allopathic autho-
rity, is fatal in about 70 per cent, of the cases :

Between the ages of 6 and 12 — 3 die in 100.
it a 16 to 20 7 a

n a 20 „ /0 20 a

The disease attacks about 130 males to 100 females ;
the male being more exposed, and, as I believe, a more
oxygenated being than the female; but according to
DietPs experience, of the females attacked, the relative
mortality is two to one against females as compared
with males.

The disease is most fatal in those of a debased constitu-
tion— as dram-drinkers, and those with kidney disease.

According to Dr. Walshe, pneumonia does not run a
less favorable course owing to the presence of tubercle,
nor does pneumonia of small extent, supervening in the
phthisical, appear to precipitate tuberculization. “ If
pneumonia be extensive, rapid breaking up of tubercul-
ised parts may follow.”

'With the exception of cholera, there probably exists
no disease the statistics of which are more copious and

200

THE LUNGS.

explicit ; and witli the exception of Asiatic cholera,
no disease the relative mortality of which is so trium-
phantly in favour of homoeopathic treatment.

Indeed, pneumonia may be considered as the grand
test disease, in the relative success accompanying dif-
ferent orders of treatment.

In 1430 cases collected by M. Grizolle, the mortality
Avas 18 per cent.

M. Louis gives a list of 78 uncomplicated cases, with
a mortality of 28 to 30 per cent.

In 126 cases collected by Drs. Walshe, Taylor, and
Peacock, 43 died, \4z., more than 30 per cent.

Of 1522 cases treated at the GlasgOAV Infirmary, the
General Hospital, Vienna, and by Drs. Walshe, Taylor,
and Peacock, 373 died, or 24 per cent.

So far for the results of allopathic treatment.

Dr. Routh, in the ‘Fallacies of Homoeopathy/ col-
lects 783 cases treated by homoeopathy, Avith 45 deaths,
or about 5 ‘7 per cent.

In 41 cases treated homoeopathically by Dr. Tessier,
of the Hotel Dieu, Paris, 3 died, or about 7 per cent.

Dr. Fleischmann, of the Vienna Homoeopathic Hos-
pital, up to 1856, viz., during twenty years, has treated
1058 cases of pneumonia homoeopathically, with a mor-
tality of 48, a4z., less than 5 per cent.

The mortality being not 2 per cent, in adults under
40 years of age, ha\4ng no other disease present.

Thus the mortality under allopathy is from 24 to 30
per cent., while the mortality under homoeopathic
treatment is from 5 to 7 per cent. only.

So startling, and at first sight so apparently impossible
a result could not be credited ; and Ave should have been
justified in seeking a solution, in part at least, from the

ACUTE PNEUMONIA.

201

variable mortality resulting at different ages,, and in
different towns, and at different periods. Accordingly,
it has been attempted by Dr. Simpson and many others
totally to ignore the homoeopathic statistics, on the
ground either of ignorance or falsehood on the part of
the homoeopathic practitioners making the returns.

Most fortunately, however, for homoeopathy, the
homoeopathic cases have been watched by enemies, with
the intention of detecting errors, but without the
slightest success.

Still the disparity between the two results is so
startling that it could scarcely be fully credited, were
it not for the corroborative evidence of Dr. Dietl, of
Vienna.

This gentleman, struck with the statements of Dr.
Fleischmann and others, but having no faith in homoeo-
pathy, resolved to put the matter to the test ; and
accordingly, for some years previous to 1847, made the
following experiments ; and being a physician to the
General Hospital of Vienna, which contains two thou-
sand beds, he had almost unlimited opportunities in
making observations. In 380 cases of pneumonia —

85 Cases were treated by bloodletting, of these 17 died, viz., 20 percent.
10G „ tartar emetic in large doses, 22 „ 21 ,,

189 „ diet only „ 14 „ 7’4 „

In the forty-third number of the ‘ British Journal of
Homoeopathy 3 is given Dr. DietPs further experiments
between 1847 and 1850. During this period he treated
750 cases of pneumonia by the pure dietetic plan only,
with a mortality of 69. The average duration of the
disease in these cases was 20 days, viz., from 5 to 8
days of febrile symptoms, and from 7 to 14 days of
convalescence.

20.2

THE LUNGS.

The expectoration was bloody in 495 cases, and
bloodless in 158 cases ; absent entirely in 55 cases, and
purulent in 42 cases.

The total mortality was 9’2 per cent., viz., in females
12 per cent., in males 6*7 per cent. Of the 69 deaths,
8 died in the stage of red hepatization, 56 died in the
stage of grey hepatization, and 5 in the stage of diffuse
suppuration, and most of the fatal cases were compli-
cated with other serious diseases.

The average duration of the disease under diet is 20
days, under bloodletting 30 days. Under homoeopathic
treatment, in 43 cases the average was under 12
days.

Thus it appears indisputable that homoeopathy not
only shortens the duration of the disease by 8 or 10
days as compared with Dietl’s results for diet only, but
about 14 days as compared with its duration under
drugging or bleeding, and that, as compared with Dr.
Dieths treatment, the mortality is from 2 to 4 per cent,
less than his, and from 15 to 20 per cent, less than that
under allopathic treatment.

Incredible as it may appear, and notwithstanding the
overwhelming testimony thus forced on the mind by
the result of the homoeopathic treatment and that of
Dr. Dietl, yet the latest works on diseases of the chest,
and those emanating even from thinking and acute
men, advocate “bloodletting especially,” from twenty
to sixty ounces, as the “ grand sheet-anchor ” in the
cure of pneumonia, together with leeches, cupping,
tartar emetic, and blisters !

So perfectly evident is it, from the results following
homoeopathic treatment and from Dr. DietTs experi-
ments, that heroic treatment in this disease annually

ACUTE PNEUMONIA.

203

kills thousands and thousands throughout Europe, that
it is only surprising that legislative measures have not,
long ere this, been enforced against such homicidal
practices.

Homoeopathy is deeply indebted to Dr. Dietl for the
corroboration which his testimony offers against the
active treatment of this, and we may therefore suppose,
of all acute inflammations — and the world should also,
in this nineteeth century, awaken to the fact that acute
disease is not some terrible demon which must infal-
libly kill man — unless some pedantic and absurd little
doctor rushes in to the rescue forsooth, with his lancet,
mercury, and cantharides.

In London, the annual mortality from pneumonia is
about 4000, of these about 2600 die from October to
March inclusive, and about 1400 from March to Octo-
ber. The cold months are thus twice as fatal as the
warm months.

As the mortality under allopathic treatment is on the
average about 20 per cent., we thus arrive at the cal-
culation that 20,000 individuals are annually attacked
in London by pneumonia, and, as we know that the
mortality in this disease under homoeopathic treatment
is only on an average 5 per cent., it follows that instead of
an annual mortality of 4000 in London from this disease
alone, were all such cases treated homoeopatliically we
are justified in stating that the mortality would probably
be reduced to 1000, and 3000 lives be saved annually.

The homoeopathic treatment of this disease consists
almost entirely in the use of Aconite, Phosphorus, Bry-
onia, and Tartar Emetic.

Dr. Tessier employs Bryonia, the 24th dilution,
almost exclusively; and Dr. Fleischmann, on the other

204

THE LUNGS.

hand, uses almost exclusively Phosphorus, the 3d or
6th dilution.

If we can judge by the returns, Tessier’s success is
not equal to that of Fleischmann, and Phosphorus has
generally been regarded as the most truly homoeopathic
remedy for this disease.

For myself, I would use Aconite in alternation with
Phosphorus in the more febrile stages, and Tartar
Emetic will often be useful in the hacking cough which
may accompany the declension of the disease.

I should employ the dilutions from the 3d decimal to
the 6th centesimal.

In typhoid pneumonia, or in such pneumonias as
may supervene in typhus or scarlet fever, in smallpox
or in measles, Rhus and Arsenicum are remedies to be
considered, together with those other remedies homoeo-
pathic to the primary disease.

In the treatment of pneumonia, as owing to the im-
pervious state of the lung the blood is ill-oxygenated,
it must be important to keep up good ventilation in the
bed-room. In cold weather by means of a small brisk
fire ; in warm weather by means of the open window
and door, taking care that the current of air do not
blow too strongly on the patient, the test of which will
be the patient’s sensations.*

The disease called pleuro -pneumonia, which has
killed so many cattle of late years, would appear more

* See ‘ British Journal of Homoeopathy,’ Nos. 31, 42, 43 ; also Professor
Henderson’s masterly ‘ Reply to Dr. Simpson’s Burlesque on Homoeo-
pathy ;’ see also Dr. Routh’s ‘ Fallacies of Homoeopathy ;’ also the review
on that singular work in the 40th No. of the B. H. Journal — illustrating
the total futility of his attack on Homoeopathic statistics. Nos. 15 and
16 American ‘ Homoeopathic Journal’ (Quarterly).

CHRONIC PNEUMONIA.

205

correctly to resemble typhus fever with pneumonia
added.

Mr. Barns, cow-keeper, treats his cows homceopathi-
cally in this and all other diseases, with, he says, a
success much beyond that of his acquaintances, who
follow' other methods.

He also, should the epidemic appear in his stables,
inoculates his sound cows with some of the purulent
matter taken from the lungs of a dead cow. The ino-
culation is performed at the root of the tail, and the
result he affirms to be prophylactic to some extent, but
in other cases the tail rots off, and the coavs take the
disease, and may die of it.

Mr. Moore, veterinary surgeon, believes that inocu-
lation is not yet proved to be prophylactic, but he is
inclined to believe that it modifies the disease, should
it supervene. He also thinks that a better inoculation
would be from an analogous disease occurring in some
other species.

CHRONIC PNEUMONIA.

Chronic Pneumonia may occasionally supervene on
the acute disease, continuing as the dregs, as it were,
of acute pneumonia, accompanied with dyspnoea, cough,
and hectic symptoms, and altogether presenting a
quasi- tuberculous aspect of things. Local indurations
from exudation matter, and depressions — accompanied
by dull percussion — weak, or harsh, or blowing, or ex-
aggerated respiration, with, it may be, increased vocal
vibrations and vocal resonance, with sub-crepitant
rhonchi, if there be bronchitis, or oedema — being also
present.

Should this state of things exist, especially at either

20 G

THE LUNGS.

apex, it may require much carefulness and discrimination
together with attention to the history of the case, to
distinguish the affection from that caused by tubercular
deposit, and especially if hectic symptoms exist.

Such a state of things may arise from the sequel of
purely inflammatory pneumonia. Cancer is another
cause. Tubercular deposit, however, is the most fre-
quent course of repeated local inflammatory attacks in
the lungs.

The Treatment. — This consists in the employment of
Phosphorus, Calcarea, Aconite, Arsenicum, daily fric-
tions with oil over the affected parts, but very tenderly
applied if there be any pain, and especially if there be
spitting of blood.

The further consideration of the medicinal and hy-
gienic treatment will come under consideration when
treating of phthisis.

(EDEMA OE THE LUNGS.

(Edema of the Lungs , like that of the sub-cutaneous
cellular tissue, consists in a watery infiltration into the
intercellular texture of the lungs.

Under such circumstances the lungs would pit on
pressure, and be heavier and denser than in health.

The percussion will be deficient in clearness, and the
respiration should furnish fine bubbling rhonchi, like
that of capillary bronchitis, with cough and aqueous
expectoration.

The Cause may be Bright’s disease, general dropsy,
bronchitis, or pneumonia, and the condition may exist
in typhus or scarlet fever, or from mechanical pressure
or obstructions, or from a mere infiltration of serum in
emphysema of the lung, or in general debility.

GANGRENE.

207

The Symptoms will be dyspnoea and tightness, with a
sense of weight; cough, and bronchial expectoration.

This state of the lungs is rarely met with as an idio-
pathic disease, and, clinically speaking, must closely
resemble aesthcnic bronchitis.

Allopathic treatment advises blisters, dry cupping,
and tonics.

Homoeopathic treatment would consist in the use of
Sulphur, Lachesis, but more particularly Bryonia, and
most especially Arsenicum, from the 3d decimal to the
12th centesimal dilution.

GANGRENE.

Gangrene, or mortification of the lungs, may be dif-
fused over the lungs in spots, but in almost all cases
exist in localised masses. Laennec in twenty-foui’ years
met with the diffused form only twice. It is a very
rare form of disease, and only met with in children and
adults of a vitiated constitution, or in drunkards. In
those, in short, in whom the putrefactive process might
be anticipated to be rapid.

In such cases it may be the sequel of pneumonia, or
it may occur in cancer ; or from the pressure of hyda-
tids, or other tumors on the pulmonary artery, or after
measles or scarlet fever, or be associated with cancrum-
oris or glanders. Sometimes it is a termination in
insanity.

It usually kills in a few days, but chronic gangrene
of the lungs is also known.

There may be haemoptysis, which will be distinguished
from that of tubercular origin by the presence of a
foetid expectoration and the peculiar leaden aspect of

208

THE LUNGS.

the patient, together with cadaveric perspirations and a
small and rapid pulse, and frothy, purulent, blackish or
ash-coloured gangrenous expectoration.

It may, however, happen that the expectoration from
a tubercular cavity, especially if there be pieces of de-
cayed tissue present, or in the chronic bronchitis of
vitiated constitutions, and sometimes in empyema, will
be extremely foetid.

But the progress and history of gangrene is very dif-
ferent from that of tubercle, and tubercular cavity pre-
cedes the foetor in the one case, while foetor precedes
the formation of gangrenous cavity in the other case.

There will be dull percussion, and if gangrenous lung
be expectorated, there will be a cavity produced.

The result is almost inevitably fatal, according to
allopathic experience, either from general prostration or
from the perforation of a blood-vessel.

Allopathic treatment consists in tonics. Chlorate of
Potash, Camphor, Yeast, Creasote, Quinine, mineral
acids ; and if there be inflammatory symptoms, leeching
or cupping is recommended.

By the homoeopathic treatment of pneumonia, scarla-
tina, and measles, we might justly expect to prevent the
invasion of gangrene in some of the cases in which a very
inferior treatment has ended so fatally, and further from
the use of Secale, Carbo-Veget., Lachesis, and Arseni-
cum especially, hopes might be entertained of saving
some cases which would inevitably perish under a less
searching allopathic treatment.

The diet must be very nourishing, such as beef tea,
milk, and wine or brandy.

“ Condy’s Disinfecting Fluid,” viz., permanganate of
potash, may be used externally and taken internally, as

HAEMOPTYSIS.

200

a deodoriser, and as its virtue depends on the abundance
of oxygen which it contains, it may be useful as a vital
stimulant.

h.emoptysis.

Haemoptysis, or spitting of blood ; hsemotomesis, or
vomiting of blood, and pulmonary haemorrhage, may
be considered together.

Blood appearing in the mouth may come from the
gums, tonsils, palate, nares, bronchial tubes, or the
air-cells, or it may come from the stomach. It may
arise idiopathically, as in the haemorrhagic diathesis ; it
may come from spongy gums, as in scorbutus; exposure
of the tooth-pulp may be the cause; epistaxis, con-
gestion about the tonsils or uvula, or from syphilitic or
other ulcerations of these parts.

Blood may be vomited in cancerous or other ulcera-
tive disease of the stomach, or from blows, or from the
sudden suppression of the menstrual or liaemorrhoidal
fluxes, as after an operation for piles by the knife or
caustic, or from obstructions in the spleen, liver, &c.

Blood may come from the bronchial tubes in the
violent cough of bronchitis, and especially in plastic
bronchitis ; but if pure blood appear in this disease
beyond a streaked sputa, tubercular disease is to be sus-
pected. Haemoptysis may further come from the air-
cells, after the over-strong or prolonged blowing of
wind instruments, or from loud speaking, bawling as
on ship-board, or in the cry of the huntsman after the
hounds, or in fits of violent passion, or during violent
muscular struggles, or from exposure to cold followed
by congestion, or from the rupture of an artery

210

THE LUNGS.

or an aneurism, or from tlie obstruction caused by
tumors in the lungs, or from cancer or hydatids, or
mediastinal tumors, or from hypertrophy of the right
ventricle. Also in idiopathic and other congestions, or
" pulmonary apoplexies,” pneumonia. The climbing of
high mountains, according to some authorities, is often
a cause of haemoptysis ; so also are wounds or blows on
the thorax.

Tubercle, however, is by far the most frequent and
serious cause of haemoptysis.

Blood may come from the lungs of the scorbutic, or
in purpurea, or in the haemorrhagic exanthementa, and
arising in minute points (petechial), yield no physical
signs.

Bleeding from what is called pulmonary apoplexy,
viz., from local congestions or effusions, produced by
hypertrophy of the right ventricle, or from regurgita-
tion from the left ventricle, may also yield no very
distinctive physical signs.

Haemorrhage has been known to take place in the
lungs, and passing into the intercellular tissue may
even cause fatal engorgement, and yet fail to exhibit
itself by haemoptysis.

Blood coming from the stomach is usually preceded
by a sense of weight and sickness, and being suddenly
expelled, there may be no more seen at that time. It
is generally dark in colour, and mixed either with thick
slimy mucus or writh food, or is acid from the presence
of gastric juice ; and if from this source, it may be ex-
pected to be found also in the stools.

Blood passing from the nasal membranes through the
posterior nares, and getting mixed with frothy mucus,
may, when coughed up, closely simulate blood coming

HAEMOPTYSIS.

211

from the lungs, but blood in small quantities from this
source is usually mixed with thick mucus.

Boys and girls have frequently bleeding from the
nose. About the age of puberty the bleeding is more
frequently from the lungs, while in old people bleeding
from the stomach is more frequent.

Haemorrhage caused by aortic aneurism may be

merely in the form of a streaky viscid expectoration, or

it mav come in mouthfuls.

•>

Haemoptysis from disease of the heart, and from
tubercle, does not often coexist in the same person.

But although heart disease and tubercular disease
are very rarely actively in progress in the same person
and at the same time, vet both diseases at different
stages of development may coexist in the same person,
although the two diseases are apparently somewhat an-
tagonistical.

We are generally taught that vicarious haemorrhage
from the lungs is not uncommon in cases of scanty or
suppressed menstruation, and that haemorrhage from
the lungs in the female is often of much less importance
than when it occurs in the male. Dr. Walshe, however,
believes that when such haemoptysis exceeds a mere
trace of blood, or when it occurs during violent action,
we are justified in suspecting the presence of tubercle.

Yet if we consider how common an occurrence is
bleeding from the mucous membrane of the nose, it
does appear singular fhat bleeding from the exquisitely
refined tissue of pulmonary capillaries should not be an
equally common and unimportant occurrence; and
Laennec believed that “ the greater number of slight
liaemoptyses were exhalations from the bronchial mucus
membrane, and were often observed to replace the

THE LUNGS.

019

/V 1 ,V

catamenia, and with a periodicity equally exact.” With
reference, however, to exhalations from the bronchial
membrane, modern investigation would appear to be
inimical to this idea.

I have at present under treatment a young lady who
has been accustomed at intervals from infancy to epis-
taxis, and being now pregnant she has repeatedly at
monthly intervals brought up from about half a pint to
two pints of frothy blood. No phthisis exists in her
family, and no signs of tubercle can be detected in
her lungs. Her pregnancy, and the periodicity of the
haemoptysis, are also inimical to the idea of the simul-
taneous progression of tubercle. Still it is impossible
to assert that tubercle is not the cause of these hae-
morrhages.

With reference to haemoptysis occurring in ascending
high altitudes, my relative Mr. Kennedy, who in com-
pany with other members of the Alpine Club, has as-
cended Mont Blanc and other snow mountains in Swit-
zerland (without guides), informs me that he never, even
at the greatest altitudes, met with haemoptysis, or even
with any constriction about the chest. Haemoptysis
under such circumstances may, however, we may easily
conceive, arise in those who become violently “ over-
blowed,” or if there be tubercles in the lungs.

Haemoptysis, if accompanying the expectoration of
acute or chronic bronchitis, unless explained by the
presence of heart disease, or by the excessive violence
of the cough, should lead to the suspicion of tubercle
in the lungs.

The expectoration of fluid blood in pneumonia would
also justify the suspicion of the presence of tubercle.

Tubercle is undoubtedly by far the most frequent

HEMOPTYSIS.

213

cause of luemoptysis, and may from this, as from other
causes, be in amount only microscopical, or it may
come welling up in mouthfuls, but usually it only
tinges the frothy expectoration.

Tubercle may cause haemoptysis by merely impeding
the circulation in the capillaries, or it may disorganize
the vascular tissue, and thus lead to oozing of blood.
If, however, a larger vessel is penetrated, then haemor-
rhage more or less profuse must follow.

Blood coming from the lungs is generally bright red,
but it may be dark either because it is venous blood, or
it may be because it has not been immediately expecto-
rated after it has passed from the artery.

The sensation in expectorating blood is often as if it
came only from the trachea, and it comes up usually
with a little short cough, or the first sign may be the
frothy saliva being found tinged with blood.

If the blood come from the lungs, there is often a
taste of blood precedes its appearance, and a sensation
of burning in the lungs.

If tubercles can be detected in the lungs, there is
presumptive evidence that red blood, if coughed up, is
from that source. But haemorrhage may be caused by
tubercular infiltration, and yet these tubercles be so
thinly scattered that no physical signs indicative of
their presence can be detected.

If the blood come from the lungs, rhonchi will
generally be found.

Treatment. — Allopathic treatment, if congestion or
fever exist, recommends bleeding, cupping, leeching, or
Tartar Emetic to nauseate. Under other circumstances,
watery purgatives, Acetate of Lead, Prussic Acid, Gallic

214

TIIJ2 LUNGS.

Acid, &c., are recommended. Dry cupping is used in
passive congestions.

Homoeopathic treatment — must have a great advan-
tage over allopathic treatment, especially in all cases
where debilitating treatment is to be especially avoided,
and as probably ninety per cent, of haemoptysis arises
from the presence of tubercle, this advantage must be
most important.

Aconite, Arnica, Arsenicum, Phosphorus, and Ipeca-
cuanha, are the chief homoeopathic remedies.

Aconite in all cases accompanied by inflammatory or
feverish symptoms.

Phosphorus in congestive cases.

Arsenicum in cases of cachexia especially.

Arnica is a remedy in nearly all cases.

Ipecacuanha in cases more especially accompanied
by faintness.

China is generally given afterwards to restore
strength.

The treatment of haemoptysis is further considered
under the “ spitting of blood” in phthisis.

Dry cupping, as sometimes practised by the old
school, is a rational method of cure, and by diverting
the circulation of the blood may be very successful as
an expedient. So also should Junod’s boot be often ex-
pected to be very serviceable.

The sympathetic action of a little salt, placed on the
tongue, may cause a contraction of the bleeding vessels
in slight cases.

The third decimal dilution is the one I should in
most cases prefer in active haemorrhage, and a tea-
spoonful of the solution may be given every five, ten,
fifteen, or twenty minutes, in acute cases.

PULMONARY APOPLEXY.

215

Tlie patient must, during active haemorrhage, be kept
very quiet, avoiding all active motion, especially with
his arms. His mind must be kept as composed as pos-
sible, and there should not be too much light in his
chamber. His food and drink should be as limited as
possible during active haemorrhage, and that which is
taken, must be taken cold. In some cases, ice applied
over the chest may be advisable, and also between the
scapulae. Sucking ice may also be serviceable. Abun-
dance of fresh air should be admitted to the bedroom,
but over-chilling must be avoided as tending to drive
the blood inwards. If there be a tendency to spitting
of blood, the individual should live quietly, and not
indulge in any violent exertion of mind or body, or in
excess of any kind, and the patient must be otherwise
treated according to the nature of the disease which
may be the cause of the haemoptysis.

PULMONARY APOPLEXY.

Pulmonary apoplexy is the name given by Laennec
to nodular, general, or diffuse engorgement of the
lungs, followed by haemoptysis.

Diffuse engorgement of the lungs apart from inflam-
matory, or cancerous, or other organic cause, is scarcely
known.

In nodulated engorgement there are, on post-mortem
examination, generally found dense masses like clots of
blood, from half an inch to two inches in diameter, and
from two or three to ten or twelve in number. Such,
when found, are chiefly at the posterior base of the
lungs.

This condition is chiefly found in connection with
hypertrophy of the right ventricle, or in mitral regur-

21G

TIIE LUNGS.

gitation, and caused, no doubt, by tlie exudation of
blood, from pressure, through tlie capillaries ; infiltrating
into tlie air-cells, or into the intercellular tissue.

According to Laennec, haemoptysis from this cause
may be profuse, but others hold that it is generally
scanty, and may be absent.

The Symptoms are dyspnoea, and dull pain, and
haemoptysis.

There are no reliable physical signs to be found if the
nodules 'be small or deep seated. If superficial there
may be discovered localised dulness on percussion, and
absence of respiration sounds.

The treatment will be much the same as for pneu-
monia and haemoptysis.

ATROPHY OF THE LUNGS.

Atrophy of the Lungs. — To some extent this is com-
mon in old age, viz., the age of repose and slow breath-
ing. In such instances the air-cells may be found di-
minished in number, and increased in size, while the
intercellular tissue is more or less absorbed. Pressure
from atrophous emphysema, pleuritic effusions, and
infiltration of tubercle, or fibrinous or other deposits
are also causes of atrophy of the lungs.

If one lung only be atrophied, or its action impeded
by mechanical obstruction, the other is usually deve-
loped in action and in bulk by way of compensation.

The respiratory sounds in emphysematous atrophied
lung will be at times, in quiet breathing, almost in-
audible ; but in full breathing may be harsh, and some-
times tubular, while percussion sounds will be clear, and
in some parts tubular.

217

VESICULAR EMPHYSEMA.

Vesicular Emphysema (e/u^vcyaco, to inflate.) By tlie
term emphysema, is meant that condition of the lungs
where the air-cells are increased in size, thereby pro-
ducing pressure, which tends to obliterate the capillary
net-work of vessels, and to cause absorption of the
intercellular tissue, whereby the blood becomes im-
perfectly oxygenated. The lung tissue is deficient in
elasticity, and mechanical hindrance is offered to the
capillary circulation.

Baillie and others referred to this disease in works of
pathological anatomy, but Laennec appears to have
been the first to give a name to the disease, and syste-
matically to describe it.

In vesicular emphysema there is general distension of
the lungs, causing a bulging of the chest, and an ex-
tension of the lungs downwards, whereby the heart may
become overlapped, or somewhat displaced.

On opening the chest, emphysematous lungs do not
collapse, as healthy lungs do, owing to the air being
incarcerated in the enlarged cells.

A certain number of these enlarged cells may
coalesce into a still larger cell ; and if this be on the
pleuritic surface, and ruptured — a rare accident — pneu-
mothorax is the result.

“ The upper division of the right lung, and the
lower division of the left, seem to suffer most fre-
quently.”

The surface of the lungs, and especially the anterior
borders, are the chief seat of the disease.

Pulmonary tubercle, according to M. Louis, is to a

218

TIIE LUNGS.

certain extent, incompatible with emphysema of the
lungs.

This may be, because two different diseases do not
often coexist in the same organ, or because the venous
condition of the blood is, as is supposed, unfavorable to
the development of tubercle, and as, according to Mr.
Rainey, oil-globules are frequently found in conjunc-
tion with emphysema, we have here a condition of
things producing oil, the enemy as it were of tubercle.
Whether this oil arises from the disproportioned action
of the liver, as compared with the lungs, seems to me
worthy of investigation.

Emphysema, in the course of years, tends to produce
hypertrophy of the right ventricle, congestion of the
lungs, bronchitic effusions, and venous congestions in
the liead.

Emphysematous cells are from the size of millet
seeds and hemp seeds, and may become, in isolated
instances, as large as walnuts; or air may penetrate
into the intercellular tissue, inflating this into irregular-
shaped cellular distensions.

Dr. Jackson, of Boston, U.S., found that of twenty-
eight cases of this disease, eighteen had one or both
parents similarly affected. Further, that if the disease
were developed in youth, nearly all such cases had
inherited it, while, if it did not appear till advanced
life, few of such had it by inheritance.

These facts prove that emphysema occurring in the
young is much more a hereditary disease than phthisis,
although the disease itself is of course very much more
rare than phthisis.

The chief symptom of emphysema is dyspnoea — a
dyspnoea which may appear in childhood, and in youth,

VESICULAR EMPHYSEMA.

219

after over-exertion, but which, increases with age, anti
becomes habitual, as the disease extends, and the lungs
become the seat of excessive bronchial exhalation.

There is a sensation of want of freedom and fulness
of breathing, and an often returning tendency to tempo-
rary bronchitic exacerbations.

The face may assume a thick dusky expression, from
venous congestion.

The bowels are apt to be habitually constipated,
while cough, accompanied by a frothy or watery expec-
toration is, if not generally present, yet very apt to
occur on slight derangements to the health.

(Edematous swellings are not apt to appear about the
aukles, except in extreme cases, or during exacerba-
tions, as when heart disease and chronic bronchitis co-
exist with the emphysema.

Physical signs. — Bulging of the chest may be local or
general, and when the disease is small in amount, or
there is much atrophy of the intercellular tissue, there
may be no bulging. This bulging may be with or
without a filling up of the intercostal spaces. Bulging
will, on examination, present a very different aspect
to the well-developed chest of the strong man, the chest
being more round and prominent than in health.

On deep inspiration the shoulders are raised, but the
girth of the thorax is little if at all increased by expan-
sion during the effort.

Expiration is very much prolonged in relation to in-
spiration, owing to the inelastic condition of the lungs,
and the tendency there exists for the air to become in-
carcerated.

The respiratory murmur may be inaudible, or it may

220

TIIE LUNGS.

be exaggerated, sibilant, or harslx ; the amount and
quality of the murmur depending, I believe, a good
deal on the force of the respiratory efforts, as well as on
the extent of emphysema present.

Occasionally a sound like that of the crackling
produced by distending a dry bladder is heard; no
doubt from the inspiratory distension of one or more
dry vesicles.

Percussion yields abnormally clear sounds, sometimes
tympanitic sounds, and if the lungs encroach on the
mediastinum, a clearness of percussion, normally absent,
will be found in that region.

Laennec believed that emphysema produced friction
sounds, but this does not appear to be the case unless
in isolated cases, it may be produced by a large and
dry vesicular prominence.

The vocal resonance may be weak or increased, and
vocal fremitus mav be increased, or be natural or dimi-
nished, depending much on the force of the voice of the
patient.

The heart’s sounds are feebly transmitted through
emphysematous lung tissue, while the heart may be
displaced, generally downwards, and the position of its
beat thus lowered, but if the emphysema be confined
to one lung, the displacement will be lateral.

Emphysema will be distinguished from pneumo-
thorax by the history of the case, viz., the sudden
occurrence of, and the more complete tympanitis of the
latter, and by the absence of respiratory murmur.

Treatment. — No treatment can be expected to restore
enlarged air-cells to their normal size, or to replace ob-
literated capillaries or intercellular tissue ; but treat-

VESICULAR EMPHYSEMA.

O 0 1

iv ,> 1

raeut may do much, to relieve the pressure of symptoms,
to control the heart’s action, to clear the lungs ol con-
gestions or of watery exhalations, and to increase the
general toue of the patient.

Allopathy recommends bloodletting and Tartar Eme-
tic, Lobelia Inflata, Ipecacuanha, Stramonium, Cannabis
Indica, &c., under different circumstances.

Homoeopathic treatment while, condemning bloodlet-
ting in all diseases, most emphatically disapprove of it
in the treatment of emphysema : a disease so habitually
accompanied by a tendency to debility and watery ex-
halations into the bronchial tubes.

Phosp., Bry., Nux Vomica, Ipecacuanha, Lachesis,
and Sulphur, but especially Arsenicum, from the 3d
decimal to the 6th or 12th centesimal dilution, are the
medicines chiefly to be considered.

This is a disease in which habitual friction over
the chest and down the sides of the spine will produce
relief, by assisting the capillary circulation in the lungs
and giving general tone.

Excessive bodily exertion must be avoided, although
relief is often obtained on brisk exercise, by which the
heart is stimulated to propel the blood through the
lungs.

Ail food producing flatulence should be avoided, and
the patient should be much in the open air, as the blood
is in emphysema imperfectly oxygenated. The skin
should be kept open by gentle perspiration, if possible,
and the hot-air bath, at a temperature of about 1 20°,
will be very suitable in such cases, especially where
active exercise is inadmissible.

For the further treatment of this disease, sec Asthma
and Bronchitis.

TIIE LUNGS.

Interlobular emphysema is caused generally by rup-
ture of some of the air-cells into the intercellular tissue,
caused by violent action or violent straining, as in partu-
rition, or on lifting heavy weights, or from violence of the
emotions. Sudden dyspnoea and pain in the chest may
be experienced, but this accident is of rare occurrence ;
and, according to Laennec, the air thus extravasated is
always reabsorbed, yet, if air were suddenly and to a
great extent extravasated, it is conceivable that death
might suddenly result from asphyxia produced by pres-
sure on the lungs.

The physical signs and the symptoms of interlobular
emphysema must be very obscure.

CROUP.

Croup is the name given to two different affections of
the larynx — viz., spasmodic croup, or laryngismus stri-
dulus ; and true inflammatory, or membranous croup.

Spasmodic croup is an affection acting through the
pneumogastric, intercurrent, laryngeal, or tri fecal
nerves, and causing spasmodic action in the laryngeal
muscles.

It comes on suddenly, perhaps in the middle of the
night, and wakens up the family often in great alarm.

It is almost entirely a disease of childhood, but may
in certain constitutions show itself in adults.

There is a wheezing and a crowing, or hacking sound
made, of a sudden explosive character ; but there is no
inflammatory action.

But as the attack may be the result of worms, teeth-
ing, or gastric disturbance, there maybe a feverish con-
dition present.

CROUP.

223

Excitement, temper, indigestible food, or exposure to
cold, are exciting causes.

Although not in itself a serious affection, it still indi-
cates the necessity for a guarded conduct in relation to
the food and regimen of those subject to jt.

Allopathy recommends Calomel, Opium, Tartar Eme-
tic, and even leeches.

The Homoeopathic practitioner will look to the cause
of the disease.

If there be teething accompanied with fever, Bella-
donna is the best remedv. If there be hoarseness,
Spongia may be required. But for the purely spas-
modic croup, especially if there be any suspicion of
deranged stomach, I have found Nux Vomica 6° act in
many instances with immediate success.

In those liable to this form of croup the diet should
generally be simple and unstimulating. Gas, if burned
in the bedroom, is probably in some cases an exciting
cause, and must therefore be discontinued, or very spa-
ringly used, or thoroughly ventilated. Abundance of
fresh air is a good preventive, although draughts of
cold air may often bring on an attack.

Inflammatory , or membranous croup , is a much more
serious form of disease.

To some extent it resembles the laryngitis of adults,
there being a wheezing, rasping, sawing respiration, and
a loud metallic cough, or a shrieking or barking cough,
with, it may be, saccharine expectoration, but usually
the cough is dry, or with a flaky mucous sputa. There
is restlessness, dyspnoea, and fever.

The leading characteristic of inflammatory croup is
the tendency to the formation of a membranous exuda-
tion of a fibro-albuminous nature. This takes place in

221

THE LUNGS.

tlie larynx and trachea, and sometimes in the large
bronchia, extending occasionally into the small bronchia.
There is seldom an exudation to be seen on examining
the throat, beyond a few patches of an aphthous kind, in
the midst of a deep redness of the mucous membrane.

This disease is chiefly found in low-lying, damp re-
gions, especially in sea-port towns, where there is a
muddy harbour, and more especially if exposed to the
east wind. For instance, croup is much more common
in Leith and Hull than in Glasgow. (Dr. Beilbie says
inflammatory croup is almost unknown in Glasgow. —
f Brit. Journ. Homceopd)

The first symptoms resemble those of a catarrh, suc-
ceeded in a few hours, or perhaps not for days, by a
ringing cough ; and if the fauces be examined, there
may at first be nothing visible but some redness ; and
perhaps there may not be any anticipation of danger,
and yet the child may suddenly die strangulated ; or
dyspnoea, blueness of the face, and expectoration of
pieces of membrane or casts of the bronchial tubes may
take place ; but often with no permanent relief, as new
membrane is rapidly formed.

The membrane formed varies from the thickness of
parchment to that of thin orange-peel.

There may not be much pain in swallowing, but the
little patient may gasp for breath, the eyes become pro-
minent, and the head be thrown back, so as to relieve
the pressure on the larynx, and the breathing is abdo-
minal.

The disease usually lasts from two to seven days.

A typhoid and malignant form of the disease some-
times manifests itself, less inflammatory, but more insi-
dious and dangerous.

CllOUP.

225

Dr. Cullen, who had considerable experience in this
disease, — Leith, the sea-port to Edinburgh, being a good
deal infected with it, — says, “ It seldom attacks children
till they are weaned, and never occurs after twelve years
of age.” From the second till the eighth year is the
period children are most liable to it ; and it would appear
to attack a greater number of boys than girls (as in
diphtheria ?).

Certain constitutions, in which the glandular system
is dominant, would appear to have a predisposition to
this disease.

The cold and damp of winter and the cold east winds
of spring are the chief seasons for the attack.

The disease may be epidemic, but it is not infectious.

All we can say regarding the pathology of membra-
nous croup is, that it is a specific inflammation, attack-
ing theswfi-mucous membrane of the larynx of children,
and throwing out a false membrane.

The origin of the disease is as obscure as that of
measles or hooping cough, but fortunately much more
rare, and no doubt often arises because of the neglect of
ordinary hygienic rules, either at home on the part of the
parents, or abroad on the part of the civic authorities.

The mixing of sea water with fresh-water mud would
further appear to be one source of the croupy malaria;
and it is not unlikely that the decomposition which
results, and the liberation, probably of Bromine , is the
result which proves so injurious.

In the 41st and 42d numbers of the ‘ British
Journal of Homoeopathy/ there is a long and minute
account given of this disease by Dr. Elb, of Dresden,
where the disease is of pretty frequent occurrence.

According to Dr. Elb, no mention is made of this

226

TI1E LUNGS.

disease till late in the seventeenth century. He says
that if he saw cases at first, the disease was usually
cured in three days ; and that, under homoeopathic
treatment, death is a rare occurrence.

The allopathic treatment recommended in this disease
consists chiefly in the use of leeches, emetics, and
mercury.

The homoeopathic treatment is very satisfactory.
According to Dr. Elb's experience, few children die of
croup under it ; and such cases as do die, we may rest
assured, must have died under any known treatment ;
while there remains, after such melancholy result, this
blessed consolation, that the last hours of the poor
little sufferer were not harassed by the cruelty of severe
treatment.

Aconite is used in the acute inflammatory stage, and
usually conjointly with Belladonna, Iodine, Bromine,
Hepar, or Spongia, Tartar Emetic, or Kali Bichro-
micum.

Phosphorus and Bryonia are used if the bronchia
are attacked, and chiefly Arsenicum in the typhoid form.
For myself, I should prefer Aconite, Bromine, and
Iodine in the treatment of this disease, in the more
acute stage, and Tartar Emetic afterwards. The dose
may be the mother tincture, or the 3d decimal dilution,
and ten drops in half a tumbler of water, a tea-spoon-
ful every twenty minutes, half-hour, hour, two, three,
or four hours, according to the urgency of the case.

Mucilaginous drinks may be given, and also milk.
In typhoid cases, wine or rum and milk should be given.

Bronchotomy is sometimes had recourse to ; but,
under homoeopathic treatment, would not appear to be
considered advisable in almost any case which was

DIPHTHERIA.

2.27

sufficiently inveterate to resist our remedies, such being
cases too inveterate for any remedy or expedient. And
certainly, allopathy cannot boast of results which are
encouraging ; for either the operation has been per-
formed where recovery would have taken place without
it, or the operation lias been of no use; the mem-
branous exudation extending either further down the
windpipe, or the child dying either from the exhaustion
attending the disease, or from the severity of the
operation.

Should there exist a predisposition to croupy attacks,
particular attention should be paid to the diet and
clothing of the child.

The diet should be nourishing, but not stimulating ;
animal food should not be taken in excess, a diet in which
milk was the leading feature being generally the best.

Tew places in England could equal Brighton as a
residence for those liable to such glandular affections
as may predispose to croupy attacks — it being always
remembered that the spring winds are as trying at
Brighton as elsewhere.

DIPHTHERIA.

Diphtheria (SitpOtpu, a skin or membrane) is the name
given to that malignant form of epidemic sore throat
which has prevailed in France for some forty years,
and in England for the last three years, viz., since
1856-7, and which is characterised by the formation, by
exudation, of an albuminous, fibrinous, or pultaceous
membrane.

This disease might be called an epidemic, malignant
membranous croup ; but, in croup, the disease chiefly
affects the larynx ; in diphtheria, more prominently, the

228

THE LUNGS.

tonsils, pharynx, and nasal passages. Still the disease
may be regarded as bearing a relation to croup, as close
as Asiatic cholera does to diarrhoea.

The disease is not a new one. It was known to the
ancient Egyptians and Greeks.

In 1557 it was epidemic in various parts of Europe.

In 1641 it carried off thousands of children.

In 1745 it spread through Europe.

In 1771 it was very fatal in America, and the great
Washington died of this disease.

In 1818 it appeared at Tours, and has been epidemic
in France ever since.

In 1856-7 it was epidemic at Boulogne, and shortly
afterwards appeared on the south-east coast of England,
and has remained with us ever since. The mortality
from this disease in England and Wales has in two years
been about 10,000.* The disease is, however, in inten-
sity, happily on the decline.

The ultimate cause of this disease is as obscure as
that of any other epidemic, such as cholera, scarlatina,
or small-pox, or the potato disease, or the grape blight.
Some French writers attribute its origin to the exhala-
tions from cesspools and privies ; and Dr. Kidd be-
lieves its appearance in England is owing to dry
putrescence, as distinguished from watery putrescence ;
the rainfall having been a few inches deficient during
the last four years.

But if the disease arises from the exhalations from
privies, why has it not always been endemic in France,
Italy, and other countries ; and as privies , as a rule,
never have had any communication with water, how can

* I have not as yet ascertained the exact number, as the Registrar
General strangely classes scarlatina and diphtheria under one head.

DIPHTHERIA.

229

it be said that deficient rainfall can affect tlieir condi-
tion? and, further, if the disease arises from defective
drainage, why should it appear in England at this
period, viz., after more has been done to drain our
land and our towns than has been previously done for
centimes ? Trousseau can find no solution of the dif-
ficulty, and says that it has equally appeared in low-
lving, damp places and high-lying salubrious places ;
and this is, in certain respects, true of the epidemic in
Great Britain.

That filth and decomposition — the stinking privies
of France and the imperfectly drained towns of Eng-
land, by depressing the vital energies, predispose certain
individuals to attacks of diphtheria, as of any other
current epidemic, may very readily be admitted, with-
out regarding it as proved, that bad smells and decom-
position are the causes of any known epidemic disease.

Still, if it be granted that the presence of filth, and
the hoarding of decomposed excrements, are active
agents in assisting the spread or development of diph-
theria and other fatal epidemics, surely a sufficient
cause is given to stimulate men to free themselves and
their dwellings from all manner of uncleanness.

Bad smells, filth, disease, crime, and moral and phy-
sical death, ever appear hand in hand ; and yet, although
it would seem to be most consistent with our ideas of
the righteous and retributive government of Providence,
that all disease should arise, directly or indirectly,
from the ignorance or the vices of men, still the law,
if it be a law, cannot always be traced. To assert that
exerementitious accumulations are the cause of diph-
theria, may be an assertion so far beneficial to men, if
it induce them to establish good house drainage, where

230

THE LUNGS.

it did not exist previously; still, if the assertion he
untrue, it will hinder the discovery of the real cause
of this and other epidemics ; and thus, like all
other mere dogmatism, produce immediate or ultimate
evil.

On the other hand, the fact that diphtheria occa-
sionally appears in the midst of refined families, dwell-
ing in noble mansions, situate in the most beautiful and
salubrious county districts, is no argument against the
doctrine of the excrementitious source of the disease ;
for, little as it may be reflected on, it is yet true, that
the majority of such mansions have either attached
to them, or in their immediate neighbourhood, dry
stinking privies ; and I have even met with cases where
the house drainage passed immediately into the orna-
mental fish-ponds surrounding the house, on which
ponds the high-born ladies of the house took daily
boating recreation, or daily fed the water-fowl !

Such arrangements are highly dangerous, and quite
inexcusable, when, at an expenditure of £10, £20,
or £50, on glazed tile draining-pipes, the sewage
might be conveyed awray to some sunk manure-well,
half a mile distant from the house, and be there profit-

ablv utilised.

Diphtheria, I believe, has been much less frequently
met with in the well-drained upland district of Tyburnia
than in the low-lying regions of Belgravia.

Another theory concerning diphtheria is, that sea-
side places are favorable to its development ; but it is,
probably, at least equally true, that at sea-side places
many have fallen victims to the disease, because at such
places the disease may have been first imported; or,
perhaps, the chief reason may lie in the fact, that

DIPHTHERIA.

231

at such places, during the visiting seasons, thousands of
children, viz., the most susceptible subjects to the dis-
ease, are congregated.

Dr. Madden believes that the growth, not the origin,
of the disease may have a fungoid cause — of the genus
o'idium, the same as is found in the potato and vine
disease ; and, on this theory, he explains the successful
results which have followed his use of the local applica-
tion of the muriate of iron, which destroys vegetable
growths. Dr. Black, however, could not detect any
fungoid growths on recently formed membrane ; and,
for myself, I confess that I have no faith in the theory
of the fungoid origin of epidemics. Where fungi
exist, I believe it is, in every case, because disease has
/we-existed ; the cause of epidemics being as yet too sub-
tile for either the chemists or the microscopists to detect.

In all epidemics, of whatever disease, the first out-
break is generally the most fatal ; and if Dr. Madden,
at first, lost a large proportion of his cases of diphtheria,
and, on a subsequent occasion, under the muriate of
iron, lost no case, there exists no argument from this
result in favour of the certain action of the last remedy,
but only a proof that the cases were less inveterate ;
because there exists no illustration in medicine, and
still less in diphtheria, of anyone remedy being invariably
successful.

Diphtheria generally begins like a common cold,
accompanied by coryza and a little uneasiness about
the throat. The submaxillary glands become swelled,
the tonsils are somewhat enlarged, and, on examina-
tion, minute aphthous or vesicular spots are discovered,
at first, probably, on one tonsil only. The exudation,
“ wash-leather like/’ then begins generally to spread

232

TIIE I.UNOS.

rapidly over tlie tonsils and pharynx. There may be
very little constitutional disturbance, and not much dif-
ficulty of swallowing ; and there may, or may not,
be salivation, accompanied by the mercurial-like odour,
or the exudation may have a pungent, putrid odour,
so strong as to pervade the whole house.

The membrane becomes easily detached in a few days,
exposing a surface which may look healthy, or raw,
or phagedenic, but it frequently re-forms. Its formation
may proceed downwards, and induce violent cough, by
which pieces of membrane are detached, and great
dyspnoea immediately give place to ease and comfort,
or asphyxia may result from the ultimate bronchia
being occluded by the exudation. The child may play
about, and the medical attendant may pronounce the
disease cured ; and yet the membrane may re-form, and
in a few hours the child may be dead. The exudation
may extend to the nostrils, and there may be spongy
bleeding from the parts affected. The disease runs its
course in from thirty-six hours to fourteen days; the
average duration being about a week.

Death may be from asphyxia, or from gradual
adynamia, or from sudden collapse.

The disease is one of great prostration of strength,
and absence of rallying power.

In a certain number of cases, as pointed out by Dr.
Atkin, the urine is albuminous, as in scarlatina.

In France, during epidemies, the diphtheritic exuda-
tion has occasionally appeared over cutaneous surfaces in-
jured by blisters or otherwise, and on the vulva and
vagina. The disease chiefly attacks infants and young
children. Between the fourth and fifth year is probably
the age most amenable to attack.

DirilTHERIA.

233

The disease would appear to be contagious, although,
on this point, the French writers are not positive ; but,
perhaps, it is more truly endemic. Dr. Madden gives
an instance in which a house appeared to become so in-
fected, that eight weeks after the disease had disap-
peared from the house, a casual visitor to the house
caught the infection and died. Two others, who visited
the house two weeks after the first attack, also took
the disease and died. Cases analogous to this have
often occurred in scarlatina.

Bretonueau says, that if the exudation touch the
mucous membrane of the attendant, it produces a diph-
theritic condition. Trousseau, however, with the ex-
perimental enthusiasm of a Frenchman, having inoculated
his own tonsils with the exudation, failed to produce
any results.

As the disease at first is accompanied by coryza, as
in ordinary catarrh, M. Bretonneau calls particular
attention to the fact, that the redness or excoriation
is confined to the nostril on the same side in which
the tonsil or glands are affected.

The following case, narrated by Dr. Black, in the
‘ British Journal of Homoeopathy/ No. 70, is pain-
fully interesting and instructive, and may be received
as a type of certain fatal forms of the disease.

Case iv. — E — , aged 6, whose sister, aged 5, had just
died from diphtheria, the exudation in her case being
accompanied by “ the most pungently putrid smell” Dr. ’
Black ever met with.

E — is a delicate-looking boy, and has had for some
time chronic enlargement of the tonsils. He com-
plained of slight sore throat on the 28th of April, and

231

THE LUNGS.

lie looked ill. There arc two or three small suspicious
points on the tonsil. The throat was freely touched
twice with dilute muriatic acid.

29th. — Hoarseness and slight pain in swallowing ;
the left tonsil is covered with a patch the size of a
shilling ; slight external swelling under and round the
lower jaw; breath not offensive. Dilute muriatic acid
applied. By noon, the exudation appeared to be spread-
ing. Iod. Mur. Acid applied, and Iod. Mur. 1, 2
grains every two hours to be taken.

30th. — As during the night croupal symptoms
threatened, the nurse, as desired, changed from Iod. M.
to Iod. 1. During the 29th, be ran about and played :
but to-day he looks dull, and is languid ; the exuda-
tion slowly spreads, and there is increased external
swelling, Dil. Mur. Ac. applied, and Mur. Ac. A. given
internally.

Vesp. — He looks better. He has spit up a large
piece of inodorous, consistent, whitish exudation, like a
flat piece of maccaroni. Continued : — Diet, chicken
broth and good soup.

May 1st. — He has passed a good night, and has spit
up many pieces of membrane. But the cervical region
is more swollen ; there is frequent gurgling noise in the
throat, which is difficult to examine ; the exudation ap-
pears in the nose, together with an ichorous discharge.
Tr. Mur. Fer. applied to the throat, and two hours after
to take Kal. Bich. 2, every two hours. Nourishing
diet, orange juice freely.

4 p.m. — He is much exhausted; a large portion of
membrane has come away ; the uvula and right tonsil
are now free of exudation ; the left is still covered ; the
submaxillary and cervical glands of left side much

DIPHTHERIA.

235

swollen; pulse 130; general restlessness. A glass of
sparkling moselle every hour, until the pulse is better.
Continued Kal. Bich. 2.

6 p.m. — He has rallied, and feels better.

I sat up with him during the night. About mid-
night, signs of extension of the exudation to the larynx
showed themselves, and rapidly became urgent. Iod. 1
given internally and by inhalation, for three hours, had
no effect; but Brom. 1, given internally, and a weak
solution of Brom. allowed to evaporate close to his
mouth, had in three hours a good effect.

2d. — Stationary; breathes and swallows easily. Con-
tinue nourishing food and wine in small quantities.
Tr. Mur. Fev. applied to the throat. My notes are
indistinct as to what medicine was given. I think,
Kali B.

3d. — Pie looks and feels better, and continued so
during the morning ; but about noon, while sitting by
his bed, I saw him suddenly seized with a fit of chok-
ing, wdiich soon abated a little. I at once gave Tar.
Emetic A. in repeated doses, to excite vomiting. A
quarter of an hour elapsed, and it had no effect ; when,
in an agony of suffocation, he sprang out of bed and
seized me. I pushed my finger down his throat, and
tried to detach the membrane from the epiglottis. This
action excited frightful fits of coughing and choking ;
but, at last, he expectorated a large piece of tough mem-
brane, twro inches long, with very marked and sudden
relief.

After this he steadily rallied, soon sat up in bed,
and amused himself, talked and played with those
around him. The swelling of the neck subsided much.
In the afternoon, he complained of sharp abdominal

236

THE LUNGS.

pains, and passed a healthy motion, mixed with many
pieces of membrane.

After 1 a.m., symptoms of laryngeal obstruction
again showed themselves ; these were relieved by Brom.

1 , internally and by inhalation. When daylight ap-
peared, he seemed better; the pulse good, breathing
easy ; now and then a paroxysm of loud croupal cough,
which caused a sense of temporary choking. Swallows
easily.

About 8 a.m., he set up in bed, quietly asked his
nurse where he should go if he died ; she answered, “ To
heaven/’ On hearing this, the little fellow quietly laid
his head on the pillow, then suddenly and tranquilly
breathed his last.

The mortality in diphtheria, as in cholera, ranges
within wide extremes ; according to the intensity of the
epidemic, ranging from 10 to 80 per cent.

In the 33 cases treated by Dr. Belcher, of New York,
there were 9 deaths.

Dr. Madden saw or treated 6 cases in 1857, with a
mortality of 5 cases. Subsequently he reports having
treated all his cases (number not given) with muriate of
iron, and all successfully.

Of 5 mild cases observed by Dr. Ozanne, all reco-
vered ; but of 8 severe cases, 6 died.

Dr. Kidd treated 4 cases, with 2 deaths.

Dr. Black gives the history of 9 cases, 3 of which
were very severe, and 2 died.

The following table is given by Daviot, as the result
of 461 cases observed in his district, in 1841-44, viz.,
40 deaths in 461 cases — less than 9 per cent. ; while the
totals do not show that the disease has any preference
for male children, as is generally stated.

DIPHTHERIA.

237

AGE.

SEX.

MORTALITY.

Mule.

Female.

Male.

Female.

8 m. to 5 yrs.

5 yrs. to 10 yrs.

— 15

— 20

— 30

—

— 40

—

— 50

—

— 60

—

227

234

Vastly more favorable results than Avere furnished
during 39 epidemics from 1557 to 1805, during which,
according to Ozanam, 80 per cent, died ; Avhile during
the epidemics from 1805 to 1830, 25 per cent, died, as
stated by Daviot.

Treatment. — The homoeopathic and allopathic modes
of treatment of this disease do not differ so materially
as they do in almost all other diseases — as in inflam-
mation, for instance, Avliere the two methods are dia-
metrically opposed.

In this disease allopathy refrains from all depletion —
the usual chief method in acute disease, and tjie
one most repugnant to homoeopathic practice. On the
other hand, homoeopathists are apparently all in favour
of the local application, as avcII as the internal adminis-
tration, of palpable doses of medicine.

Homoeopathic treatment. — Dr. Madden found, during
the first outbreak of the disease, no medicine of any
avail, and the mercurials positively injurious. Subse-
quently, all Dr. Madden’s cases have recovered under

238

THE LUNGS.

muriate of iron locally applied twice a day, with gly-
cerine also applied three or four times a day. Under
this treatment, he says, “the swelling and redness
rapidly subside, excessive fetor rapidly decreases, and
the deposit gets everted and falls off.” He also employed
Biniod. of Mer., and Bich. of Pot., and Ars. 3, and
Am. Garb. 1, if there was very great prostration.

Dr. Kidd regards Iodine and Mur. Acid as the great
remedies, and Arsenic in great prostration, and Mercury
in putrid salivation.

Dr. Black uses Iod., Brom.,* and Kali Bich., chiefly ;
and Glycerine or Mur. Acid locally.

Dr. Ozanne recommends Bromine of the 2d centesi-
simal and Bromide of Potassium in the 1st decimal tri-
turation.

Dr. Belcher, and other American authorities, strongly
recommend Bromine and Brom. of Pot.

Tartar emetic is also recommended, when the disease
descends to the larynx.

Nit. Acid, Bell., Lachesis, and Biniod. Mer., are
also recommended.

Glycerine, locally applied, is generally allowed to be a
solvent of the membranous deposit. A solution of the
per Chlor. of Iron, as a gargle, should also be used.

If Glanderine could be relied on, the putrid and
nasal forms of the disease seem to me to afford a good
opportunity for its employment.

The Diet. — All agree that this should be as nourish-
ing as possible. Chicken-broth, beef-tea, the essence
of beef, milk and rum, brandy and water, port, sherry,

* The dose of Bromine and Iodine given is about a drachm of the
tincture to half a pint of water ; and of this solution, a teaspoonful every
quarter of an hour to two hours.

DIPHTHERIA.

239

champagne ; and when food cannot be taken by the
mouth, Dr. Kidd recommends injections of food, one
ounce at a time.

Ventilation should be very freely employed, and the
patient can be easily removed from one room to
another.

Cordy’s disinfectant fluid, viz., the Manganite of
Potash, can be used both as a deodorizer in the house
and as a deodorizing gargle. It can also be taken as
an oxygenating stimulant, and is well worthy of a
trial.*

Allopathic treatment. — Dilute Muriatic Acid, applied
to the membranous spots; Nitrate of Silver, solid stick
or a strong solution ; ditto. Glycerine.

Calomel, emetics, and tracheotomy.

The French writers appear to have much faith in the
use of Nitrate of Silver ; the strength of four grains to
half an ounce, applied by a piece of sponge to the tonsils
and epiglottis, or injected into the nasal passages.

Tracheotomy has been performed 17 times by Bre-
tonneau, with successful results in 5 cases.

Trousseau has performed the operation 36 times, with
success in 9 cases.

The canula used is recommended to be as large as
convenient, as it is apt to get closed by membrane.

The French writers also recommend the trachea to
be mopped with a solution of Nit. of Silver, through
the opening made by the operation.

♦ See ‘British Journal of Homoeopathy,’ Nos. 66, 68, and 70, for
papers by Drs. Madden, Black, and Kidd. 4 North American Journal of
Homoeopathy,’ Nos. 8, 11, 12, 20, and 30, and especially Dr. Belcher’s
paper, in No. 19. Also, especially, the Memoirs of Bretonneau, Trous-
seau, &c., as translated by the New Sydenham Society, 1859.

240

TIIE LUNGS.

PHTHISIS.

Phthisis ((j)0t(x>, to consume) is the name given to that
ff consumption of the lungs ” which is the result of the
growth and destruction of tubercle.

Tubercle, or scrofulous deposit, as it appears in the
lungs, is at first an unorganised, semi-transparent, grey
deposit. This gradually consolidates into a yellowish,
albuminous, cheesy substance, under the name of crude
tubercle; and this, in the progress of the disease, having
a low vitality, is softened down, opens itself a passage
into the bronchia, and is expectorated with its accom-
panying pus — the result being a cavity large in propor-
tion to the mass of tubercle expectorated.

Tubercles the size of millet seeds, or hemp seeds, may
be sprinkled over a district in the lungs, or masses the
size of cherry-stones, may be encysted and isolated, or
they may appear in clusters; and these clusters gene-
rally, after a period of growth, become united into solid
masses.

The presence of tubercle, acting as a foreign irritant,
will cause cough; at first without expectoration, but
afterwards with the expectoration of mucus, tubercular
matter, pus, or blood.

The expectoration of softened masses of tubercle
must produce a cavity. The walls of this cavity may
become lined with a semi-cartilaginous membrane, and
be thus healed, or be healed in the form of a cicatrix ; or
on the other hand, the cavity may continue to secrete
pus, until the patient is exhausted by continual irrita-
tation and loss of substance and strength.

Physicians speak of three stages in this disease :
first, the deposit of tubercle; second, the softening of

PHTHISIS.

241

this deposit; and third, the expectoration of this deposit
and the production of cavities.

Consumption may be acute or “ galloping/’ but in
nine cases in ten the disease runs a chronic course.

Causes of Consumption. — Laennec and many others
lay much stress on long-continued gloomy passions, bad
food, and dark ill- ventilated houses, but Louis thinks
these have not yet been demonstrated to bear more
directly on phthisis than on any other chronic disease.

Dr. T. Thompson says depressing passions, by causing
imperfect respiration, most likely predispose to the growth
•of tubercle; and Dr. Baly says that the inmates of
prisons throughout Europe and America are particularly
amenable to phthisis. Notwithstanding the scepticism
of M. Louis, the universal belief is that all depressing
circumstances and passions peculiarly predispose to the
production of consumption, and that this belief cannot
be demonstrated more perfectly, is one of the most
striking illustrations we possess of the extreme difficul-
ties which beset the attempts to demonstrate the truth
of theories in medicine.

Dr. T. Thompson gives the subjoined table :

Annual per centage of Deaths from Phthisis.

Per cent, of
Illegitimate
Children.

, London

Men.

•451

Women.

•377

3-2

Liverpool

•595

•571

3-6

Manchester & Salford...

•549

•548

5-8

Leeds

•440

•477

England & Wales

•378

•408

Paris

•208

•408

28-

From the above table, Dr. Thompson draws the con-

242

THE LUNGS.

elusion that the depressing passions predispose to
phthisis, the ratio of the female mortality as compared
with the male increasing with the proportion of illegiti-
mate children, that is, with the unhappiness of the
female part of the population.

I think, however, it may be asked, — Is the male popu-
lation not the most unhappy part of the community,
with their strong passions, excesses, and business anxie-
ties ? and is the female mortality in Paris not in excess
of the male mortality, because the females are shut up
in shops, &c., while the males are much in the open
air?

That the disease is contagious to some extent is be-
lieved by Laennec, Andral, and others, who would not
recommend those of delicate chests to be much in the
same atmosphere with the consumptive.

I have seen several instances in which there appeared
some corroboration of this view, but I have not seen it
anywhere stated that the nurses at the Consumption
Hospital are more than normally amenable to the
disease.

Hereditary transmission is regarded by M. Louis as
only demonstrable in one tenth of his cases, while at
the Brompton Hospital one fourth of the cases are said
to be hereditary; and certainly, of all predisposing
causes, the hereditary taint has always been regarded as
the most prominent.

Aggravated cases of syphilis and mercurialism are
probably further predisposing causes of tuberculization.

Physical signs. — In no disease is a knowledge of
physical signs more imperatively demanded than in
consumption ; and there is no doubt that without this

PHTHISIS.

213

knowledge in former days, many individuals were de-
clared to be truly phthisical, and banished to foreign
countries, the temporary or persistent wasting of whose
bodies arose from diseases having no connection what-
ever with the growth of tubercle in the lungs.

If an individual be suspected of being phthisical, the
region first examined is that in the neighbourhood of
the clavicles, and chiefly the sub- clavicular region.

The reason for this is that, if tubercle exist in the
lungs, it almost always shows itself in the clavicular
region, and if it exists elsewhere in the lungs it is
almost invariably to be found in that locality also.

Another reason is, that the presence of the clavicles
and their comparative prominence afford a test of the
comparative depression existing on either side.

Lastly, the chest walls in this region being thinly
covered with muscles, the external form of the chest is
a more trustworthy index to the form of the subjacent
lung than exists in other parts more thickly covered,
and therefore this region is also more amenable to
exact auscultation and percussion.

It must, however, be remembered that the right cla-
vicle in right-handed men is often more prominent than
the left. Also that if both apices be affected with tu-
bercle, no comparative depression may exist on either
side. Further, the clavicles may not arch but recede
with the corresponding lung and rib depressions. And
lastly, the presence of tubercle may cause no depression,
as emphysema may coexist in the same region, and
more than compensate for that contraction which the
presence of tubercle causes, by the occlusion of minute
bronchia and air-cells, or by the contraction caused by
exudation matter.

THE LUNGS.

244

The amount of vocal resonance and vocal fremitus
yielded by the clavicular region is not a very trust-
worthy evidence as to the presence or absence of tuber-
cle, because the vibrations of this region are so much
influenced by the size of the neighbouring bronchi. It
must further be remembered that normally the
resonance is greater at the right apex than at the
left.

The trained, and quick, and sensitive eye and hand,
may detect on full inspiration, if tubercle be present, a
movement more resembling an up -heaving than the
expansile movement of health, and in making this
observation, it must not be forgotten that the normal
expansile movement in the upper part of the chest is
most conspicuous in the female.

During the early stages of phthisis, when tubercles
are thinly scattered at the apex, gentle percussion above
and below the clavicle may elicit a fine shade of super-
ficial dulness, and on patting this region with the pulps
of the first two or three fingers, this dulness may be
rendered more apparent.

In these operations, the proximity of the trachea and
main bronchi must be remembered, and, on the other
hand, allowance made if the muscular development be
greater on one side than on the other.

The larger bronchus of the right side should, theo-
retically, somewhat modify the percussion sound of the
sub-clavicular region of that side.

If any dulness exist in one side on percussion, it will
be more manifest after full inspiration and full expira-
tion, as compared with the sound side.

If tubercles be thinly scattered, equally below both
clavicles, it may be next to impossible from percussion

PHTHISIS.

215

to prove their presence, the opportunity of comparison
being wanting.

The greater the deposit of tubercle, the greater will
be the d ulness on percussion, unless the mass of tubercle
reach a main bronchus, when percussion might be tu-
bular, or unless coexisting emphysema mask the
tubercular deposit.

If tubercle exist in patches, the respiration will be
obscure over such patches, but exaggerated or aspirated
in their immediate proximity.

Interrupted , or jerking, and also cogged-whecl respi-
ration, especially if confined permanently to a limited
region, is an important sign of tubercular infiltration,
but general interrupted respiration is often a spas-
modic or nervous symptom, and it exists locally in the
regions of pleuritic inflammation.

Dr. Gerhard, of Philadelphia, pointed out that respi-
ration is normally more blowing at the right than the
left apex, owing to the larger calibre of the right
bronchus.

M. Louis has also shown that in 22 healthy young
females, e<rpiration at the apex was inaudible in 13 at
the left side, and in only 5 cases at the right side.

If the heart sounds be more audible at the right
apex than at the left, the sign may, if others exist, be
regarded as corroborative evidence of consolidation.

In forming an opinion on the signs furnished when
incipient phthisis is suspected, the possibility of a pneu-
monic or capillary bronchitic origin to such signs must
be considered.

During the second stage, or that of softening of the
tubercle, the dulness is increased, and so also by this
time has the flattening of the affected part increased;

246

THE LUNGS.

although from the probable sinking of the clavicle this
flattening may be less conspicuous than when the
clavicle projected from the chest.

In this stage humid crackling or bubbling rhonchi
are also to be heard, and the breathing becomes more
or less blowing or bronchial in the affected region.

In the third or excavation stage, the percussion may
be wooden, but it may also be tubular, if the dense
tissue surrounding the cavity communicate with a large
bronchus — or if the cavity itself be large, the percussion
may be tubular, or amphoric, or of cracked metal
sound.

The respiration over a cavity near the surface may
be hollow, hoarse, blowing, cavernous or amphoric.

The cough as heard over a cavity is cavernous, and
metallic echo or metallic tinkling may also be heard.

The voice may be heard as pectoriloquous, amphoric,
broncliophonic, natural, weak, or, if no bronchus com-
municate with the cavity, the voice may not be heard.

Whispering pectoriloquy, of all signs, is the most un-
mistakeable sign of a cavity, but if no bronchus com-
municate with the cavity, from temporary or permanent
occlusion, this will be unheard; and in some cases a
dilated bronchus, surrounded by indurated tissue, may
furnish pectoriloquy, but rarely whispering pecto-
riloquy.

Under happy circumstances, masses of tubercle have
become expectorated, and the cavity, being lined with
a semi-cartilaginous membrane, or cicatrised, the dis-
ease, at least for many years, has made no further pro-
gress.

Such being the case, a certain amount of depression,
with dulness on percussion, and weak or harsh respira-

LOCAL AND GENERAL SYMPTOMS.

247

tion, may be anticipated as the permanent physical
signs, viz., the signs closely analogous to those which
might also be left in certain cases by a localised pneu-
monia.

LOCAL AND GENERAL SYMPTOMS.

Cough. — The cough differs from that of catarrh,
being unaccompanied by coryza. It may appear for
the first time after exposure to wind, or after severe
mental or bodily excitement, and is usually for weeks
or months dry and short, or paroxysmal. It is often
referred to the throat, the sensation being as if some
little plilegm required to be removed from that region.
The sensation may also be referred to the pit of
the stomach, and a pain is often felt between the
shoulders.

The cough is at first dry, or perhaps accompanied by
a little jelly or mucilage-like expectoration, there being
sometimes a deposit in the expectoration like barley-
water — a symptom which Dr. "Walshe thinks occurs
only in phthisis.

As the expectoration proceeds, it becomes mucous,
with white striae, resembling the expectoration of a
severe cold in the head, and from this it becomes more
and more purulent, of a yellow, green, or dark grey
colour, and is expectorated with jagged or smooth
edges, each sputa remaining separate, or the whole
forming one mass. Dr. T. Thompson says the expecto-
ration, if delivered into water, assumes the form of balls
of cotton wool.

Sometimes profuse purulent expectoration suddenly
takes place, either from the abrupt evacuation of a

248

THE LUNGS.

cavity, or from profuse secretion from the walls of a
cavity or from the bronchi.

The amount varies. Young children generally swal-
low the sputa, and I have known it to be swallowed by
a young woman, who died of phthisis, apparently with
the intention of concealing from me and others the
nature of her disease.

The sputa in advanced phthisis often contains sugar,
the result, I believe, of abnormal liver action.

Spitting of blood occurs in four fifths of the cases of
tubercle in the lungs. Louis says in two thirds of the
cases. It is often the first symptom of phthisis, and
may precede all other symptoms for months, or even
years. The quantity may vary from a few microscopic
spots to streaks of red or yellow in the sputa, or it may
appear as pink and frothy spit, or it may be a decidedly
bloody spit, or it may be brought up suddenly to the
amount of several pints. A drachm to an ounce is a
frequent range in a first haemoptysis.

Spitting of blood is usually more profuse in the male
than in the female, and most so in the sanguineous
temperament ; it is, however, a more frequent symptom
in the female than in the male.

The cause of blood appearing in the expectoration is
either of a tubercular pneumonic origin, or from tuber-
cular destruction of the minute vessels, or perhaps from
the pressure on these vessels from the tubercular impe-
diments. Louis believes the majority of cases are by
exhalation. The haemoptysis does not increase with
the progress of the disease as might be anticipated,
probably because, first, the patient lives more carefully ;
second, because the heart diminishes in force with the
progress of the disease ; third, because the tubercular

LOCAL AND GENERAL SYMPTOMS.

249

deposit is at first more in tlie fine tissue of the lungs,
viz., at the extremities of the blood-vessels, than is the
case after tubercle begins to be deposited in mass.
Sudden death from haemoptysis from tubercle is almost
unknown, and although it may be a sign of rapid ex-
cavation, yet in itself the spitting of blood does not ap-
pear to hasten the fatal termination of the disease.

Of 300 cases of haemoptysis, in the experience of M .
Louis, 3 proved fatal from the loss of blood only.

The microscope may discover in the sputa blood-
disks, oil-globules, calcareous particles, pus-cells, tuber-
cular matter, fragments of lung tissue, of blood-vessels,
or of nerves ; and the discovery of such substances may
in a few cases afford the earliest testimony to the exist-
ence of phthisis.

Dr. Walshe has known calcareous particles and
masses from the size of a pin’s head to that of a pea, to
be expectorated for years.

ilf the stomach be delicate, which is often the case
with the phthisical, the cough may induce sickness or
vomiting.

Shortness of breath is a symptom which generally
shows itself from the beginning; viz., when there may
be a mere sprinkling of tubercles, hence it cannot in this
stage arise from want of lung tissue, but would rather
appear to be from the debility of the muscular tissue
generally, and also from the debility of the heart.

Pleuritic or neuralgic pains in the chest are often a
premonitory sign of phthisis, and such pains may be
referred to the remotest possible position from the spot
where tubercle is deposited — for instance, the pain may
appear under the short ribs of the right side, when

tubercle can only be detected at the left apex.

250

THE LUNGS.

In about twenty per cent, of the cases there is scarcely
any pain, and the pains even during excavation are re-
ferred much more to the pleuritic surfaces than to the
tubercular cavity itself.

Hectic Symptoms. — Fever and rigors chiefly towards
the evening, and night sweats, generally accompany the
softening of tubercle, with its accompanying formation of
pus.

These sweats may be so violent as to raise the epider-
mis in blisters.

During this stage the pulse, as a rule, is quick and
soft, and there is usually thirst, and perhaps sickness
and vomiting, especially if the cough be severe.

The pulse is from 90° to 120°, and this, if persistent, and
if no other explanation presents itself, is strongly suspi-
cious of acute tuberculosis ; and whereas the pulse in
health is usually about one fifth accelerated if the indi-
vidual rise from the sitting to the erect position, in
phthisis it is only accelerated a few beats.

The bowels may be constipated, as during the dry
feverish state of the skin ; or diarrhoea may come on
during the sweating stages.

Diarrhoea, however, is often kept up by the presence of
ulceration in the ilium, jejunum, colon or rectum, and
this ulcerative diarrhoea is frequently the immediate
cause of a fatal result. Glandular tissue being especially
amenable to tuberculization — the glands of the intestinal
canal, mesentery, fauces, larynx, neck and axilla are
frequently the seat of disease in the consumptive, but
the growth and ulceration of tubercle in the neck or
axilla would appear to afford some protection against
the development of tubercle in the lungs.

LOCAL AND GENERAL SYMPTOMS.

251

A red or blue line at the edge of the gums, especially
opposite the lower incisors, often appears in the phthisi-
cal ; but it also appears in scurvy, and in many cases of
general bad health, and indeed is rarely absent among
the middle-aged working classes, or from the gums
which are not kept clean and healthy by brushing.

Dr. T. Thompson thinks the sign especially significant
of phthisis in the female.

The mental condition of the phthisical is in the
majority of cases, peculiar and interesting. Hope, faith,
refinement, a love of the beautiful and the devout, are
often met with.

The personal beauty of the phthisical is also pro-
verbially recognised in their rich hair, clear eyes,
transparent teeth, delicate skin, and slender fingers.

In the ‘ London Journal of Medicine/ 1851, I pointed
out in my paper, “The Liver the hydrogenator in
animals,” the marked antagonism which exists, mentally
and bodily, between the subjects of tubercle of the
lungs and those afflicted with liver disease ; showing
that, in the phthisical, beauty of person and piety of
mind were as conspicuous as the opposite qualities were
in those afflicted with liver disease.

Is this activity of the glandular system, so peculiar to
the phthisical, the explanation of the transparency and
beauty of the tuberculous ?

Emaciation is often the first, and it may be for a long-
time the only symptom observed in the victims of
phthisis, and with rare exceptions this increases with the
progress of the disease.

The ends of the fingers, generally become bulbous, and
the nails large and ovoid, as tuberculization advances.

In some cases the hair becomes thin and falls off ;

THE LUNGS.

while in other cases there is a superabundance of thick
hair on the beard and head.

Swelling of the ankles is a frequent result in advanced
cases. Menstruation generally ceases as severe wasting
by sweats and otherwise sets in.

The sexual instinct of the male, and the amatory sen-
timents of the female, are somewhat actively developed
in the early youth of the tuberculous ; but the power
of the male becomes diminished with the progress of
the disease, while the fecundity of the female is probably
increased.

The existence of pregnancy is popularly believed to
retard the progress of consumption ; and, theoretically,
this should be true, as two abnormal actions, if I may
use the expression, rarely co-exist in the same person,
and therefore the growth of the foetus in the uterus
should retard the growth of tubercle in the lungs.

In the blood the red corpuscles are somewhat deficient,
while the proportion of water is plus.

The urine of the phthisical occasionally contains a
minute proportion of sugar, probably, I believe, as
with the sugar in the sputa, arising from that altered
condition of the liver so frequently met with in the
phthisical .

Pneumonia, or pneumonic attacks, are apt to appear
during the progress of tuberculization of the lungs —
partly because tubercle may act as an exciting cause,
and partly because the phthisical are very amenable to
the influence of cold.

Pneumonia limited to one apex, may of itself be one
of the first indications of the presence of tubercle ; but
Dr. "Walshe has known pneumonic signs limited to the
m/ra-elavicular region, and not of a tubercular origin.

LOCAL AND GENERAL SYMPTOMS. 253

M. Louis points out that tubercular pneumonia is
not so fatal an accident as idiopathic pneumonia — a
result which appears to me to be sufficiently explained
by the fact that pneumonia occurring in the phthisical
would certainly not be treated with that harshness which
allopathy employs against the purely inflammatory form
of this disease ; for as has been often demonstrated, and
as is shown in the account of pneumonia in this volume,
the active treatment of this disease is directly homi-
cidal.

Pleuritic attacks, with or without effusion, are also
frequent occurrences in the progress of phthisis ; and
M. Louis considers double pleurisy as almost certainly
of tubercular origin.

Tubercular perforation may penetrate the pleura, and
lead to pneumothorax, accompanied by intense pain
and dyspnoea ; but such severe symptoms may be
wanting, the physical signs of pneumothorax only
being present. M. Louis found death to result after
perforation, in from rfvelve hours to eight days, while
some survived for months, and cases of recovery have
been recorded.

Bronchitis, chiefly of a local origin, must occur
during the presence of tubercle in or contiguous to the
bronchi.

This localised bronchitis is chiefly to be found at one
apex or at one base.

Ulcerations of the epiglottis and larynx, accompanied
by pain at the thyroid cartilage, are frequent occurrences
in phthisis.

If the chordee vocales are affected, hoarseness and
more or less aphonia, are the results.

Chronic peritonitis is often accompanied with a tumi-

25L

TIIE LUNGS.

ficd condition of the abdomen ; and, according to Louis
(if kidney disease be excluded), is almost certainly
tubercular. Ulceration of the bowels, according to the
same authority, occurs in five sixths of the cases, and the
phthisical may die from the diarrhoea caused thereby
before tubercles have been much increased in the lungs ;
but fistula in ano (contrary to the general belief), he
says, is of rare occurrence in the history of phthisis.

Fatty enlargement of the liver is a frequent occurrence
in the phthisical ; but it is said not to be so generally
the result in England as in France.

This fact is very striking, viz., the hypertrophy of
the liver when all the other parts of the body are ema-
ciated, and it seems to point out some as yet not clearly
demonstrated antagonistic relationship between the
lungs and the liver as the two primary constructive
organs.

Tubercle in the meninges of the brain, so frequently
a fatal occurrence in scrofulous children, is comparatively
rare in adults sinking from pulmonary phthisis ; but
cephalalgia and delirium are frequently met with towards
the final close of the disease.

The phthisical also occasionally perish of cerebral
disease before the pulmonary malady has much advanced,
the symptoms of which attack very closely resemble
those of typhus fever.

Tubercle, and indeed cavities, may exist in the lungs
of individuals who may yet assert that they have never
had a bad cough, and never suffered from shortness of
breath. Yet such individuals have probably suffered
from feverishness, debility, loss of appetite, more or
less emaciation, restless nights, pains in the bowels, or
chronic diarrhoea, viz., a series of symptoms not point-

DIAGNOSIS OF PULMONARY TUBERCULIZATION. 255

ing to the lungs as the scat of their origin, until, per-
haps, suddenly the expectoration of some blood may
reveal the cause.

Before the occurrence of such bleeding, however, “ a
single tap,” says Dr. Walshe, “ above the clavicle, will
sometimes give a ready clue to what has hitherto been
utterly mysterious.” In the experience of Louis, latent
phthisis occurred in 8 cases out of 123.

The chief peculiarity of a case like the above, is the
assertion on the part of the patient as to the absence of
cough. But it is easy to conceive that tubercle might
be deposited and expectorated without producing pain,
or any violent cough; while the cough sufficient to
expectorate the softened tubercle might either be con-
cealed or overlooked.

DIAGNOSIS OF PULMONARY TUBERCULIZATION.

Diseases such as hectic fever, the formation of ab-
scesses, chlorosis — marasmus from the loss of fluids,
dyspepsia, or mental depression — chronic bronchitis, or
cough, with or without expectoration, from dyspepsia,
elongated uvula, and liver derangement, &c., may all
produce many symptoms closely simulating those of
pulmonary phthisis. And there can be no doubt that
in the days gone by, and even at the present day, such
cases have often been considered and treated as cases
of consumption, and the victims, perhaps, banished to
foreign countries, or, if cured, boasted of as illustrations
of the cure of consumption effected by some particular
man, or under some special line of treatment.

The means of diagnosis furnished by auscultation and

25 G

THE LUNGS.

percussion should render such mistakes almost impos-
sible, and yet it is by no means certain that an over-
weening and perhaps pedantic reliance in physical
diagnosis alone, has not sometimes led to a one-sided
and false view of the cases submitted to the physician
for an opinion.

Statistics do not prove that much assistance in diag-
nosis can be derived from the statements of hospital
patients as to the absence or presence of the hereditary
taint of consumption. There is no more general belief
than that consumption is hereditary, and yet this belief
is very imperfectly borne out by the statements
received at hospitals. The ignorance of the bulk of the
working classes, viz., such as appear before hospital
physicians, as to the nature of the disease their parents,
and especially their grand-parents, died of, may explain
to some extent the discrepancy between the popular
belief and the acquired statistics.

Louis could positively ascertain the fact of hereditary
transmission in only one tenth of his cases, while at the
Brompton Hospital one fourth of the cases are said to
be hereditary.

This, however, is certain, that the carefully brought
up children of a consumptive parent do often escape
phthisis, while the ill-fed and exposed children of robust
parents fall victims to that disease.

The left lung in the female, and the right lung in the
male, is respectively, to some extent, most amenable to
the growth of tubercle, but pathology does not attempt
to explain the cause of this, and not much reliance can
be placed in it with reference to diagnosis.

There can be little difficulty in determining the pre-
sence or absence of tubercle in the lungs when it has

DIAGNOSIS OF PULMONARY TUBERCULIZATION. 257

accumulated sufficiently to yield distinct physical signs,
but it is easy to conceive that tubercles may be so
thinly scattered over the lungs, or so placed that it may
be almost impossible to discover their presence.

In such instances no sensible man would give more
than a guarded opinion, and yet it may be under such
circumstances that a positive opinion would be most
valuable, for it might be then or never that a course
of treatment, or line of life, or the choice of a pro-
fession, might possibly avert the further spread of the
disease.

If there be a short cough — which continues for weeks
in spite of the remedies employed — it will be well to
inquire as to whether this may arise from stomach or
intestinal irritation, habit, elongated uvula, enlarged
tonsils, worms, nervousness, liver disturbance, uterine
irritation, pleuritic affections, emphysema, heart disease,
or tubercle.

Cough may arise from tubercle, and yet this be so
thinly scattered through the lungs as to yield no physical
signs, yet if this cough continue, and especially if it be
aggravated on each return of cold weather, and if it be
a little short cough, or a paroxysmal cough, and none
of the above causes of cough afford evidence of their
presence, the probability of tubercle as the cause must
be then well considered.

If this cough subsequently be accompanied by a little
mucilaginous expectoration, the probability of the pre-
sence of tubercle is increased, although a long-continued
dry cough, from any cause, may at last be accompanied
by sputa of various kinds.

If there be with the above, wandering or local pains
in the chest, the probability of tubercle is further in-

258

TIIE LUNGS.

creased — but wandering or local pains may be neuralgic
or purely pleuritic.

Loss of flesh and dyspnoea are further proofs, although
long-continued disturbance from any cough may pro-
duce loss of sleep, and of flesh, and the weakness fol-
lowing produce dyspnoea. But if a young adult of
regular habits, and free from mental depression, and
from spermatorrhoea, or secondary syphilis, or cancerous
disease, steadily loses flesh, there is a justifiable sus-
picion of incipient phthisis.

The expectoration of blood, either frothy or pure,
accompanying cough and wasting, be it much or little,
is a very important symptom, but blood may come
from the nares, gums, ulcerated tonsils, and uvula, or
from the stomach. It may also come from the throat,
and even from the bronchi with violent cough, and blood
from the lungs may be vicarious with menstruation, or
be the result of heart hypertrophy, &c.

If to the presence of cough, wasting, and bloody spit,
even although the merest trace only of blood appear,
and that only once, there be added jerking, divided, or
harsh, or prolonged respiration, and especially if there
be also dulness, ever so slight, at one apex, the dia-
gnosis is almost certainly tubercle , if cancerous deposit
be excluded.

If there be superadded chronic hoarseness of voice
— not syphilitic — the diagnosis is further confirmed,
and “ if to the above,” according to Dr. Walshe, “ deep
inspiration evoke a few clicks of dry crackling rlionchus
the diagnosis is next to absolutely certain, and espe-
cially if these clicks subsequently become moist/’

Localised pneumonia may indeed yield signs and
symptoms exactly analogous to the above, viz., bloody

DIAGNOSIS Or PULMONARY TUBERCULIZATION. 259

spit, dulness on percussion, rough and dry respiration,
succeeded by moist clicking, but pneumonia limited to
the clavicular region is generally tubercular.

Louis says, “ chronic peritonitis in a person aged more
than fifteen years, if abdominal cancer be excluded, in-
volves as a necessity the existence of tubercle in the lungs,”
if, as Dr. Walshe adds, “ Bright’s disease be also absent.”

Pleuritic attacks, with effusion, persisting in spite of
treatment, and also chronic diarrhoea, not to be ac-
counted for by liver or other exciting cause, is strongly
suspicious of the presence of tubercle in the chest and
abdomen.

The presence of cancer, heart disease, emphysema, or
leuco-luemia, are inimical to the co-existence of active
tuberculization.

The spirometer affords no trustworthy test of the
presence or absence of tubercle in the lungs. A feeble
or nervous person will yield small results, wdiile an
energetic determined person wdll yield large results,
even although tubercle be present.

Chronic and localised pleuritis, pneumonia, or bron-
chitis, may be accompanied by spitting of blood, or
muco-pus, and yield local dulness on percussion, with
wasting and hectic, and thus very closely simulate
phthisis ; and even if these affections be not suspiciously
localised, the effects produced will yet render the physical
exploration of the lungs, with reference to tubercle,
often difficult and uncertain in the early stages.

The respiratory sounds, especially in hysterical and ner-
vous women, vary widely in the same individual from day
to day, and vary with the present energy of the indivi-
dual from hour to hour, or even within a few minutes,
and therefore in doubtful cases repeated and long-

2G0

THE LUNGS.

continued auscultation may often be necessary. Dr,
Walslie says, “ Jerking respiration, even although local,
in hysterical women, and harsh respiration limited to
the right apex in any woman, or very slight dulness at
the right apex in man or woman,” is compatible with
the absence of tubercle.

Dr. T. Thompson observes that “hysterical women, especi-
ally if there be amenorrhcea, may feel pain in the lungs,
and have local hysterical congestions, and spit blood.”
On the other hand, hysteria may co-exist with phthisis.

The luxuriance of the hair on the head and on the
eyelids, and the transparency, so to speak, of the eyes,
skin, and teeth, together with the length of the long
bones of the body, viz., the fingers, arms, and legs ;
may sometimes afford, with the presence of delicate
health, and especially cough, a strong suspicion of the
presence of tubercle, and no doubt such a conformation
is often the subject of phthisis, yet such individuals
often contrive to enjoy a long life, wThile the fat, plump,
rosy, and sanguineously robust, may suddenly be seized
and die of acute consumption. Yet I think it may
generally be observed that those belonging to the latter
category, have generally become, as it were, prematurely
ripe and hilarious, and all must have occasionally
observed abnormally robust parents of the above
hilarious type produce children several of whom have
died of early phthisis.

Death from phthisis is generally the result of a slow
wasting of the vital energy. It may not take place
until the greater part of both lungs has become disor-
ganised, but it often results from that loss of rest and
strength which results from the incessant irritation
caused by a cavity in one lung.

DIAGNOSIS OF PULMONARY TUBERCULIZATION. 2G 1

• Superinduced pleurisy with copious effusions, I believe
to be a more frequent cause of death under allopathy
than under homoeopathy.

The same also I think may be said with reference to
death from super-induced diarrhoea or pneumonia.

Bright’s disease, tubercular meningitis, perforation of
the pleura or peritoneum, or general dropsy may be the
fatal termination.

Louis gives as the result in 307 cases, noted from the
first appearance of symptoms :

4 died within 1 month.

»» 3 ,,

ii 3 „

» G „

,, 9 „

1G0

264

That is, 43 out of 307 survived two years, while more
than one half died within nine months, the weak often
living longest.

Of 205 cases —

100

Age.

15 to 30

Average duration..

11 mouths 17 days.

34 — 45

„ 20 „

45—50

ft 7 ft

61 — 68

Of 196 cases —

56 were strong.

87 moderately 6trong.

53 were weak.

The above average duration of life is drawn chiefly
from hospital experience, and no doubt life would be
considerably prolonged in those whose circumstances

262

THE LUNGS.

admitted of carrying out the best hygienic aids — in
reference to climate, food, house-ventilation, exercise,

&c.

The eases are also drawn chiefly from the lower
classes, in whom wasting disease generally runs a
more rapid course than in individuals of the middle class.

I am not aware of the existence of any statistics re-
garding the results of the homoeopathic treatment of
this disease. But as the intercurrent attacks of pleu-
risy, pneumonia, bronchitis, and diarrhoea, can all be
treated much more successfully by homoeopathic reme-
dies than by strong vexatious or depleting measures, it
is only a logical inference that life will be prolonged
beyond the above periods under the homoeopathic treat-
ment of such exacerbations as may occur, and this quite
irrespective of the advantages which may result from
the general homoeopathic treatment of phthisis.

The number who die annually of phthisis in —

England and Wales, including London, is about 50,000
London „ 7,000

From which it appears that the mortality from phthisis
in London is below the average of all England, town
and country.

How mysterious, that so large a proportion of the
population should die from a disease the essential cause
of which is not fully demonstrated, and the drug treat-
ment of which is so unsuccessful. But what an infinite
field for labour in the highest direction which medicine
can take, viz., the raising of the social and hygienic
condition of the people, and the prevention of disease.*

■

* For ten years I have kept a record of my own personal friends, irre-
spective of patients, who have died, and I find that of 136 individuals so

203

ACUTE OH “GALLOPING” PHTHISIS.

Phthisis sometimes runs an acute course, appearing
in those previously considered healthy, it may be after
some exposure to wet, or after some depressing mental
labour, and running its course in from three weeks to
six months.

Although tubercles, to a considerable amount, may
become developed in a month, yet, in cases of acute
phthisis generally, it is most probable that it is not so
much the rapid growth as the rapid softening of tubercle
that characterises the disease. It is a disease some-
what analogous in its history to acute consecutive ab-
scesses, which sometimes attack scrofulous children.

From the unexpected appearance, great prostration,
occasional delirium, and other acute symptoms of this
form of disease, it may sometimes be mistaken for pul-
monary abscess, with hectic fever, purulent bronchitis,
suppurative pneumonia, or typhus fever.

TIIE TREATMENT OF PHTHISIS.

The treatment of phthisis has two objects in view ;
first, to arrest, if possible, the further development or
progress of tuberculization, by improving the health
generally ; second, to treat such symptoms as may arise
in the course of the disease.

The first object is endeavoured to be obtained chiefly
through hygienic means, the second chiefly through the
action of medicinal agents.

recorded, 30, or more than one fifth, have died from tubercular disease.
1 mention this as the statement that, about one fifth of the population die
from tubercular disease is to casual observation almost incredible.

261

THU LUNGS.

The medicinal agents employed in the allopathic
treatment of consumption are chiefly as follow :

Counter-irritants, in the form of blisters, croton oil,
turpentine, and Tartar Emetic, &c.

Stoll, Broussais, and others, have recommended re-
peated bleedings, the actual cautery, and issues.

Tincture of Iodine is often applied over the seat of
active tuberculization or inflammatory action, with the
view of arresting their progress.

Laennec recommended a sea-weed ward, and says that
of the cases he so treated, some remained stationary or
were arrested.

Dr. Ramadge says those primarily chlorotic are never
phthisical, and that enlarged tonsils, emphysema,
chronic catarrh, &c., as they impede expiration, thus ex-
pand the lungs, and therefore no tubercle is developed ;
and hence the use of his inhaling and exhaling tube,
practised from five minutes to half an hour three times
a day, prevents the further growth of tubercle, and is
not only not irrational, but is analogous to nature’s
method.

Phthisis is said to be rare in mountainous districts,
and I think we may ask, is this merely from the purity
of the air, or is it not in part from the full inflation of
the lungs which habitual hill-climbing necessitates?

For cough, allopathy recommends Opium, Hydro-
cyanic Acid, Aconite, Hyoscyamus, and Digitalis.
Also the inhalation of Naphtha, Oxygen, Hydrogen,
Carbonic Acid Gas, Chlorine, Iodine, chloroform, or
steam, or “ leeches over the sternal notch,” have been
recommended.

As tonics. Iodide of Iron, Quinine, bitters, and mi-
neral acids, are given.

TIIE TREATMENT OF PHTHISIS.

2G5

Inflammatory attacks supervening “ may require
cupping, or general bleeding, and blisters.”

Dr. Preston, in the * North American Journal of
Homoeopathy/ No. 13, warmly advocates the plan of
giving medicine by inhalation, and certainly in phthisis
this method may have the double advantage of being
direct, while the inhaling process will expand the lung
tissue.

Spitting of blood is attempted to be controlled bv
lowering remedies, and sometimes bloodletting, leeches,
blisters, or emetics, or ice to the chest, or the inhalation
of turpentine.

For Nausea. — Effervescing mixtures, Creosote, iced
water, &c., are given.

For Diarrhoea. — Rhubarb, Castor Oil, Opium, rube-
facients over the abdomen, and blisters are used. Also
Sulphate of Copper, Acetate of Lead, &e.

For Perspirations. — Vinegar and water sponging,
gallic acid, mineral acids, &c., are administered. Also
Oxide of Zinc, Cod-liver Oil, Quinine, and Nitric Acid.

For Peritonitis. — Rubefacients, blisters, and Mor-
phia, endermically employed.

Fistula in ano, if it occur in those declining with
phthisis, is not to be attempted to be cured by the
knife.

M. Louis made experiments with all the remedies
chiefly used by the French practitioners, such as Pro-
tioduret of Iron, Chloride of Sodium, Sal Ammoniac,
Sub. Carb. Pot., Chlorine Gas, Chlor. Lime, Digitalis,
Ilydroc. Acid, Creosote, Iodine, and came to the con-
clusion that none of these agents, in his hands, did any
real service.

The homoeopathic treatment of the intcrcurrcnt symp-

266

TIIE LUNGS.

toms arising in the progress of eonsumption differs very
materially from the above.

But in the first place, during the incipient stage or
in those predisposed to tuberculosis ; in conjunction
with hygienic treatment, an attempt should be made to
retard the progress of tuberculization, by the nightly
administration over a lengthened period of remedies,
such as Calcarea and Phosphorus in alternation, and
with this view I should prefer the 6 centesimal dilution.

Dr. C. Muller (See ‘ British Journal of Homoeopathy/
No. 6i) recommends the Chloride of Iron, and Dr. C.
Luther, in No. 62, says, that at “ Nudersdorf, in Prussia,
where there are chalybeate springs, consumption is un-
known.This is an interesting fact, well worthy of
investigation ; but it must be remembered, that at Tun-
bridge Wells and other chalybeate districts, consumption
is not uncommon.

Dr. Churchill, on the ground of Phosphorus being
deficient in the blood of the phthisical, advocates the
use of the Ilypopliosphates of Soda and Lime, and lays
claim to great success.

Dr. Peters, homoeopathist, New York, has long advo-
cated the use of the Phosphates of Iron and Soda, on
the ground of Iron and Phosphorus being deficient.
(See f North American Journal of Homoeopathy/
No. 30.)

See also Dr. Beneke’s paper in the f British Journal
of Homoeopathy/ No. 67, on the necessary influence of
Phosphate of Lime on cell growth.

Dr. Plitcliman lays great stress on Zinc, Nux, Nit.
Silver, in the premonitory stage of phthisis.

Dr. Epps speaks highly of Calc., Lycopod, &c.

In the treatment of pneumonic, pleuritic, and bron-

THE TREATMENT OF PHTHISIS.

207

cliitic intercurrent attacks, Phosphorus and Bryonia, of
the 3° decimal dilution, will be generally highly ser-
viceable, and are infinitely to be preferred to blisters,
leeches, or bloodletting, which must be regarded as
especially dangerous in a disease, to arrest which can
only be possible if the general strength of the patient
is maintained. Indeed, allopatliists confess that their
treatment of tubercular infiammation is their weak
point in the treatment of phthisis.

To allay cough, homoeopathy employs : — Aconite,
Ars., Bry., Bell., Conium, Hyos., Ipec., Squill., Sepia,
Phos., Lach., Carb. Veg., and many other remedies ;
and although relief is thus often obtained, and the evil
results which the indiscriminate use of Opium entails
avoided, yet that incessant cough which often occurs in,
and which in other words is consumption, viz., the exca-
vation of tubercle and the expectoration of this and pus,
cannot, in the majority of cases, be arrested by any
remedies, and very frequently cannot even be alleviated.

It is under such circumstances that expedients must-
be had recourse to, and as cough occurring night after
night, must prevent sleep, and the patient become the
subjectof intense suffering and exhaustion; it is certainly
advisable to secure if possible temporary relief by Opium,
Hyoscyamus, Conium, or Cannabis Indica, administered
in palpable doses of ten or twenty, or ‘more drops of the
tincture of the pharmacopoeia at bedtime, so as, if
possible, to secure some sleep or rest.

These observations have especial reference to the
third stage of phthisis, when all hope of saving the
patient is abandoned, and when all that can be hoped
for, is a little peace and rest for the poor sufferer.

Relief to cough may sometimes be obtained by in-

268

THE LUNGS.

haling hot- water vapour, and sometimes by manual
frietion over the diseased parts of the lungs, even
although the cause of the cough be a cavity secreting pus.

Milk warm from the cow, will, in some eases, where
there is much irritation and cough, be the best diet.

Mucilaginous drinks often afford some relief.

The exhibition of Belladonna, Aconite, Phosphorus,
Hyoscyamus, Arnica, Camphor, &c. by hot-water in-
fusions in an inhaler, is worthy of repeated trials.

This, however, must be remembered, that the inces-
sant administration of homoeopathic remedies in ad-
vanced phthisis will often irritate rather than relieve ;
just as removal even to a fine climate has often hastened
the progress of the disease. Under such circumstances
our chief efforts must be directed to securing, if possi-
ble, quietness and rest for the patient, bodily comfort,
and that diet which is most suitable.

Dyspeptic symptoms are relieved by Nux Vom., by
Puls., Ars., &c. and especially by Nitrate of Silver, or
Sulphate of Copper, if there be an ulcerated condition
of the mucous membrane of the stomach or intestines,
and by Tartar Emetic and Arsenic for gastritic symp-
toms, and Ipecacuanha for nausea.

Spitting of blood appears to be often very amenable
to Aconite, Arsenicum and Arnica, giving us another great
advantage over the blood spitting and blisters of the old
school.

In excessive cases Junod’s boot, (see c British Journal
of Homoeopathy/ No. 43,) or ice to the chest may be
employed, while at the time and for days following great
quietness should be observed.

Respirators should be worn, while there is a tendency to
blood-spitting, during cold windy weather especially, or

TIIE TREATMENT OF PHTHISIS. 209

in going from hot into cold air, but under other circum-
stances the respirator should be worn as little as pos-
sible.

Diarrhoea, if not ulcerative, responds readily in
most cases to Mercurius ; and if ulcerative, Mercurius,
Nitrate of Silver, and Arsenicum are still very service-
able.

Perspirations are much relieved by tepid sponging
with vinegar and water — sponging with hot water, and
then changing the night-dress, affords much comfort,
while Calc, and Mercur., and Ly copod., are also suc-
cessful remedies ; also dilute Sulphuric Acid, viz., about
one drop to the ounce, viz., about the twentieth part of
the allopathic dose.

The hot-air bath, at about 120°, might also be tried
homceopathically.

Peritonitis is treated chiefly with Lachesis, Ars.,
Bry., and warm fomentations, and the allopathic
blisters and endermic application of morphia, very safely
dispensed with.

For restlessness and sleeplessness Coffea in tincture
may be used — as already mentioned, opiates may be ne-
cessary in the final stages ; but sponging the body and
abundance of fresh air, are often excellent soporifics.

Cod-liver Oil contains, according to Dr. De Jongh :

Iod '029

Chi. and Broin. ’084
Plios. Acid ... -053

Phos -007

•173 = about 1 part in 600.

Medicinal substances all homoeopathic to irritative
or inflammatory action in the lungs.

270

THE LUNGS.

This is a remedy employed by both schools of
medicine in the treatment of tuberculization, the
difference chiefly being in the size of the dose adminis-
tered ; for while in allopathic practice a tablespoonful
three times a day, is a common dose, and sometimes
double this amount ; for myself, I believe that the
merits of the oil are better secured by giving a tea-
spoonful at night, or twice a day. This small dose
rarely interferes with digestion, and I think the medi-
cinal effects of the oil are better secured.

The chief advantages of the oil are that it often
arrests emaciation, diminishes the wasting, corrects and
improves the appetite, and renders the individual al-
together more comfortable.

It agrees generally better with the young than the
old, that is, as I should suppose, with those who have
most reparative power.

In the f London Journal of Medicine/ vol. for 1851,
I endeavoured to show that the growth and regeneration
of tissue in the animal economy, is mainly due to the
action of the oil-globules which appear in the chyle
immediately after the chime is mixed with bile; and I
draw the inference that the merit of Cod -liver oil con-
sists chiefly in its supplying an oil analogous to the oil
of chyle.

The Iodine, Chlorine, and Bromine, &c., also found in
the liver- oil of fishes, doubtless serves a useful purpose
in the tuberculous, just as the presence of such sub-
stances infinitesimally in sea air may be useful in glan-
dular disease — but although the chemist can analyse
cod-liver oil, and can thus manufacture an oil chemi-
cally the same, by mixing the inorganic ingredients with
other oils, yet no such mixture has ever been found

THE TREATMENT OF PHTHISIS.

271

equally serviceable to the oil manufactured by nature
herself, and found in the liver of fishes.

Dr. T. Thompson, from experiments carried out at
the Consumption Hospital, found all vegetable oils very
inferior to cod-liver oil, except cocoa-nut oil, which he
found in somes cases as serviceable as cod-liver oil.

Tubercle being a low organization, and phthisis being
the consequence of this, the use of fish-liver oils is both
theoretically and practically a scientific work.

Theoretically I should also conclude that the liver of
any fish, and, indeed, the liver of young lambs and
calves, as a food, would be found serviceable.

The popular remedy of snails boiled in milk, I believe,
has the same natural foundation. The snail is an
animal whose liver is in bulk about one third of the
entire animal, and the snail itself is therefore composed
almost entirely of fat.

Pulmonary consumption is a rare disease in Iceland,
in consequence, some have thought, of the abundant
consumption of fish by the inhabitants. Another form
of scrofula is, however, present in Iceland, in the form
of rickets. I am not aware whether oatmeal is much
used in Iceland, but is not rickets a less common dis-
ease in oat-consuming Scotland, than in Avheat- and
bacon-consuming England ?

Cream, especially with those who cannot take cod-
liver oil, is always regarded as an excellent nourishment
for the consumptive; and cases of cure from an exclu-
sive milk diet are recorded “ after physicians had pro-
nounced them to be hopeless.”

Professor Simpson, some years ago, drew attention to
the fact of the wool-workers in the cloth-making dis-
tricts of Scotland being comparatively free from phthi-

27.2

THE LUNGS.

sis ; and lie drew the conclusion that this arose from
the oily nature of their trade, their clothes being gene-
rally saturated with oil ; and he recommended inunction,
after the manner of the ancients, as worthy of con-
sideration.

But was phthisis not less common when, before the
introduction of cotton, woollen garments were much
more universally worn ? — and is this supposed immunity
from phthisis among cloth- workers not due in some
degree to their woollen garments ?

But however this may be, manual frictions with oil,
especially over the chest, perseveringly followed out, are
worthy of long and repeated trials, and must, at least,
be infinitely more serviceable than the blistering and
other counter-irritants often recommended by allo-
pathists.

Dr. B. llichardson recommends inunction with oil at
night, and washing with Liq. Ammonia in the morning,
by which a soap is formed.

Inunction with the ancients was only a part of the
process their skins were subjected to. The more im-
portant part was the hot-air or steam-bath, by which
the seven million pores of the skin were called into
strong depurative action, while the cold water after-
wards used braced the cutaneous nerves.

If by these means effete products were eliminated to
a very great extent, and the skin thus rendered hardy
by the cold water reaction, the process must have been
very highly conducive to that health which purification
must induce ; while the bracing process must have ren-
dered the subjects of it very independent of change of
temperature. That this is the case I have seen illus-
trated in a manner and to a degree scarcely credible ;

THE TREATMENT OF PHTHISIS.

273

and I cannot but regard the neglect into which this
ancient practice has fallen as a great loss to those of
the present day, especially to those who now suffer
equally from the heats of summer and the chill damps
of winter.

This question naturally leads to that of climate,
because, if the systematic use of the Turkish bath can
render the patient to a great extent independent of
changes of climate, the necessity for seeking warmer
climates than that of England is, to some extent,
obviated.

But change of air must, independent of temperature,
be regarded as the most truly natural or homoeopathic
cure for all diseases, and especially of the lungs — just
as change of diet is for dyspeptic affections, or change
of scene and occupation for nervous brain affections.
And it must be remembered that change of air often
implies change of scene, change of food, change of
one’s total surroundings, thoughts, feelings, and state
of being.

The general idea on the minds of nearly all, that an
increased temperature is one of the chief elements sought
after for the consumptive, must often be a mistake.

That temperature must be best for the consumptive
which is the best for his digestion and the best for his
general health and sensations ; and there are a large
number of cases which become rapidly worse wThen
removed to hot atmospheres, but which become invigo-
rated and improved on removal to cold bracing climates.

So much is this the case, that a voyage in a whaler
to the North Seas has been known to stop, at least for
the time, all the symptoms of a confirmed consumption.
And this is to be said in favour of cold clear climates, that

274

TIIE LUNGS.

oleaginous food can, in such climates, be more largely
taken, and more easily digested than in mild climates.

That climate is the best in which the patient can
most enjoy life in the open air.

Cold east winds are almost always detrimental ; and
certainly the chief aim in removing to warm climates is
that the patient can remain almost every day, and
nearly all day, in the open air.

To shut up the patient in warm relaxing rooms must
be as bad a treatment as possible, in almost all cases.
Daily exercise in the open fresh air should, even during
rainy weather, if po-ssible, be persisted in as long as pos-
sible.

Italy is said to be too relaxing in hot weather, and
too exciting in spring ; while the spring winds are often
extremely trying.

The North of Africa, and especially the Nile, are
now recommended as preferable to all other places ; but
the difficulty of obtaining comfortable lodgings and
suitable food must be a serious barrier with the delicate
and fastidious against a residence in Algeria. Indeed,
Englishwomen, and men also, find almost all foreign
places “ uncomfortable ” and uncongenial.

Children, especially, who show symptoms of tubercu-
lization, should, if possible, reside during the winter in
climates sufficiently warm to enable them to be for
several hours daily in the open air, and to have open
windows when in the house.

To those who can afford the time and expense, and
have strength to bear the fatigue and fr discomforts,”
no doubt foreign travel must be a source of great
change, and therefore of great pleasure and advantage
to the valetudinarian ; but I do not believe that any

TI1E TREATMENT OP PHTHISIS.

275

country in the world — if the quality of the food and
the domestic comforts especially he considered — affords
a more desirable residence than that which can be
found, according to the season, in the range from the
bracing Grampians of Scotland to the sunny and balmy
sea coast of the South of England.

Some physicians have spoken highly in favour of
daily emetics as a cure for consumption ; but few would
be so rash, in the present day, as to have recourse to so
rough a measure. Yet a long sea voyage, with its total
change of scene and air, and its accompanying vomiting
in rough weather, has, with those strong enough to pass
through the ordeal, been sometimes highly beneficial.

Dr. Livingstone says that the climate of central South
Africa, is perfect — balmy, and yet bracing and elastic —
and that consumption is unknown among the negroes
of that region.

In No. 31 of the ‘ North American Journal of Ho-
moeopathy/ the negroes of North America are stated to
be peculiarly prone to phthisis, proving that the immunity
enjoyed by the South African negro is not from race.

Australia and New Zealand are often spoken of in
general terms as having a good climate for the consump-
tive; but the winds in New Zealand are excessively
boisterous, while the towns of Australia have dry, dusty,
and exhausting climates, although some of the country
districts possess dry and balmy climates.

Generally speaking, the patient must be a better
judge of the climate which suits his case than the phy-
sician can be, and his choice will depend somewhat on
his tastes and habits.

The centre of South Africa might be a paradise to
the valetudinarian sportsman, Egypt to the deep student

276

TIIE LUNGS.

of tlic past, and tlic South of England to the lover of
home and its comforts.

Certainly there could he no greater error, and few
prescriptions more cruel, than to banish a timid and
apparently dying woman to some foreign climate merely
because it is warmer, and merely for the chance of pro-
longing life for a few months.

According to a note, p. 804 of Dr. Ramadge’s edition
of Laennec —

In Iceland, the mortality from pulmonary consumption is rare.

Rome

°/<

Stockholm

Berlin

Vienna and Munich

Naples

Genoa

London

Paris

Marseilles

I think there must be some errors in the above.
Vienna is generally considered to have as large a pro-
portion of consumptives as Paris or London, and Rome
a larger proportion than 5 per cent. The mortality in
London is about 12 per cent.

Mr. Keith Johnson states that phthisis is compara-
tively rare in Siberia, Orkney, and Shetland. Ex-
tremely hot and extremely cold climates would appear
to be nearly equally inimical to the growth of tubercle,
which flourishes chiefly in the more temperate climates,
but especially in those liable to the vicissitudes of tem-
perature.

That climate is not so wonderfully a curative agent as
is supposed is strikingly illustrated by the fact, that the
proportional mortality for phthisis is nearly equal in all

THE TREATMENT OF PHTHISIS.

2 77

tlie temperate climates of Europe — in sunny Italy as
well as in foggy England ; while the same holds good
of the British troops at home or in Malta, Canada, the
West Indies, or Gibraltar. Further, in Europe nearly
as many cases show the first symptoms in the warm
part of the year as in the cold months. The mortality
also is nearly as great during the warm months as during
the cold months.

For some further observations on climate I refer the
reader to a subsequent page in this volume.

I have said that the chief advantage of a residence in
a warm climate is, that the consumptive may live com-
fortably in the open air, instead of being obliged to
snatch a mouthful of air, as it were, and for the rest
shut himself up in warm rooms. This leads naturally
to the question of Ventilation.

It is to be regretted that those fiscal powers which
impose constraints on the construction of houses, and
of house and street drains, do not extend their authority,
and insist on all newly-built houses being provided with
an approved system of ventilation.

The Arnott ventilation is of use so long as a fire is
burning in the grate of the room so ventilated, but is
of no use during those seasons when no fire is lighted,
or during the night, when the fire is not in operation.

A separate series of ventilating tubes, connecting
each room of a house with the kitchen flue, might,
when a house was being built, be applied at a trifling
expense, and would act as constant ventilators, day and
night, summer and winter. I have given a detailed
description of this process in the volume for 1857 of
‘ The Transactions of the Association for the Promotion
of General Science. ’

278

TIIE LUNGS.

It is singular tlic dread most people have of fresh air,
and the constant fear they have of “ catching cold,” if
exposed to the action of air colder than that of the warm
room they may be generally sitting in.

Those who brace themselves w'ith cold sponging in
the morning, and especially those who take the Turkish
bath, have little fear of the bugbear “ fresh air,” and
can, except in thick foggy weather or smoky neighbour-
hoods, sleep with their windows open all night, in winter
as well as in summer.

It is difficult to picture a more ridiculous violation of
natural laws than is exhibited at many large “ evening-
parties,” when the rooms are crowded with people all
vitiating the air, gas flaring up and burning the oxygen,
giving carbonic acid, sulphuric acid, and sulphuretted
hydrogen in exchange ; while the shutters are closed,
the curtains carefully drawn, the doors kept shut,
and the votaries of amusement choking with heat and
“ closeness.”

Add to this the late hours, the champagne (?) suppers,
and the cold drive home, in perhaps a damp cab, and
a better prescription could not be given for engendering
tubercle in those predisposed to its growth.

Tailors, dressmakers, bakers, flax-spinners, needle-
grinders, viz., those most exposed to close air, are most
amenable to consumption ; while farmers, butchers, and
even dustmen, breathing in the open air, are much less
liable.

According to Dr. Arnott, of sixty monkeys shut up
in “ a nice warm room,” but without ventilation, fifty
died in a month, and all had tubercles in their lungs.

Diet. — The food taken by the phthisical should he

TIIE TREATMENT OF PHTHISIS.

279

especially well cooked, and, although not stimulating,
should yet be varied and palatable, and that which expe-
rience clearly proves to be most easily digested. I know
of no other rule which can be given.

Dr. Gully says, “ There never was tubercular deposit
with a sound digestion.” Certainly there is often tuber-
cular disease with what is called a good digestion ; but
in the sense of sound digestion, including true assimila-
tion, it is true. Badly-digested food must produce bad
tissue.

I believe, however, that many who are persuaded that
they cannot maintain their strength unless they partake
liberally of “ meat ” and beer, would find, after a fair
trial, that a diet chiefly of milk and farinaceous and
vegetable substances would furnish greater powers of
endurance, and render the body less susceptible of at-
mospheric changes.

The best cocoa nibs boiled, and then, if necessary,
when cold deprived of their oil, when that cannot be
digested, and an infusion, not too strong, with abun- •
dance of good milk, is a most admirable beverage.

If there be any one article of diet better than another
as the staple food for the phthisical, or those predis-
posed to tuberculization, it is milk — milk, the most
essential and simple of all food — in the desert, the all-
sufficient food of children, warriors, old men, and horses ;
but not that milk which is forced from scrofulous cows,
shut up in dark London alleys.

Asses’ milk may sometimes lie digested when cows’
milk is found too heavy ; but it should not be forgotten
that the donkey, like the cow, is the subject of tubercle
in the lungs if kept in close stables ; and an ill-used
donkey can scarcely be expected to furnish good milk.

280

THE LUNGS.

Careful mastication and temperance are to be as
closely attended to as possible.

Stuffing, with the view of keeping up the strength, is
a strange delusion, believed in by most English valetudi-
narians and by many English physicians. The digestive
powers of the tuberculous are often impaired, and there-
fore, and especially in children, must not be over-
tasked.

To digest a moderate quantity of food well, must be
better than a load of ill-digested food.

The phthisical mother should not suckle her child.
That child should be suckled by a strong country
woman, or, if this is unattainable, it should be fed on the
new milk of one cow.

A certain amount of indulgence, compatible with
temperance should be allowed to all valetudinarians,
because the pleasure thus derived acts favorably. The
moderate use of tobacco, tea, and wine may come under
this category — although, strictly speaking, such things
should be almost excluded.

Of meats, roast mutton is usually the best. Oysters
are often much appreciated ; and veal or chicken-broth,
taken slowly, and not too hot, are to be recommended.

Hygiene. — The general hygienic management of those
who are supposed to have a tendency to phthisis, or those
in whom tubercle has already, to an appreciable extent,
become deposited in the lungs, is a subject almost too
extensive to enter upon, in a medical treatise on dis-
eases of the chest, because it is a question which
embraces the entire education and conduct of the indi-
vidual from his cradle to his maturity.

Sir James Clark and others have entered largely into

THE TREATMENT OF PHTHISIS.

281

the question; hut, probably, Dr. Combe's work on
‘ Physiology as applied to Health/ is the best book ever
written on the subject. It has gone through very
many editions, and may be said to have originated in a
popular form, in this country, the science of hygiene.
Dr. Combe is always in earnest, and yet lie never
exaggerates. Miss Nightingale's ‘Notes on Nursing/
are also full of a surprising minuteness and yet breadth
of counsel on domestic hygiene. Some will regard her
opinions as extreme ; but there are few managers of a
household who may not, if willing, derive much profit-
able instruction from the perusal of her book.

Tubercle may almost be considered the synonym for
every error in the moral and physical life and con-
duct of men, or of society. It is that which thrives
in darkness and filth, or in those vitiated by under-feed-
ing or over-feeding, or depressed by lowering passions.

Take the most healthy child, and subject it to bad
treatment — feed it on gin and adulterated bad food —
clothe it in filth and rags — shut out the air of heaven
from its skin and from its lungs — have a cesspool or
bad drain communicating with its dwelling — and let its
bed be in a dark foetid chamber, habitually filled with
vile men and women, and it will be a strange thing,
indeed, if tubercle is not engendered in the lungs, brain,
or abdomen of this victim of low life.

Again, select the most beautiful young debutante of
the season ; — compress her waist, “ not much, but only
a very little into shape /' let her go the round of a
London season, and, during four months, attend one
hundred and twenty balls, dinners, and operas, and
nightly, for four hours, breathe the foetid atmosphere
of fashionable places ; let her go nightly to bed at or

282

THE LUNGS.

after 2 a.m., partake of green tea, Champagne, and
other stimulants, to “keep her up ;” lie in bed to
bieakfast, and for the rest read novels, and it will
again be strange if this victim of high life— should there
be any predisposition— has not, at the end of the season,
more or less tubercle discoverable in one of her lungs.

And so also, take one of the opposite sex, and let
him run the course of a “ fast young man” for a few
years, and he also may congratulate himself if, in
sowing his wild oats, he has not also sown the seeds of
consumption.

Men have this advantage over women, that by their
athletic and field sports they to a great extent
counteract the evil physical results of a dissipated life ;
but they suffer from that loss of vital fluid— begun,
perhaps, at school, although ignored by boarding-school
masters — which, if excessively wasted, must contribute
more than any other cause to lower the vital and manly
energies of youth.

Further, although the primary object of marriage —
physically considered — is, that the human race may be
preserved ; and that a race may be reared to “replenish
the earth, and subdue it;” yet, of the hundreds of
thousands of marriages contracted, how infinitely small
is the number of those who take any prospective view
of the case in this direction ; and, in relation to an
offspring, at once good hearted and strong bodied;
and how few are there among the upper classes, and
these mothers to be— the votaries of pleasure, who,
bearing within themselves the germ of some future
human being, think it necessary to restrain themselves
in their usual routine of worldly amusements; while,
with a carelessness approaching to indelicacy, the young

THE TREATMENT OF rilTIIISIS.

283

and middle-aged habitually go the round of dancing
in hot rooms and at late hours indiscriminately at
all periods of the month. Can we wonder, under such
circumstances, at the existence of a wide-spread local
debility, and at the general incapacity, as mothers, of
the over-civilised women of our day.

Man has wonderful powers of adaptation, and may
enjoy good health, under the brilliant heat of the
tropics, and in the gloomy regions of the Northern
Seas ; yet there does appear to our senses to be a
purity, freshness, and rosy luxuriance in summer
mornings, which makes late hours and the substitu-
tion of gas for sun-light something like a sin ; and the
idea attached to the existence and growth of tubercle,
is that of a depraved, dark, foetid, and evil vegetation,
as distinguished from the fragrant and rosy growths of
the morning.

Dress. — The costume of the phthisical should be such
as they can bear with comfort; but, under the regene-
rating and invigorating influence of early hours, baths,
exercise, and fresh air, the mind and body somewhat
rebel against all over-caudling. Of dress, generally, it is
a curious manifestation of mind, which, under the name
of fashion, permits women, strong or delicate, to ap-
pear with inconvenient bareness, and demands that
strong men should be buttoned up and choked, and
made to swelter in rooms full of effete air, in dresses
of tight black woollen cloth — with collars to their coats,
waistcoats, and shirts, strangulating their necks, and
congesting their brains.

As a rule, dress should be as light as it can be worn
with comfort ; and in hot weather especially, young and

TIIE LUNGS.

284.

old sufler much 1 11 this and other countries from over-
clothing— fashion compelling all to go about stifled,
as it were with clothes. In cold weather it appears to
me even more necessary to have the abdomen warmly
clothed than the chest.

Those who are strong repudiate flannel, and it is
certainly the fact that most of those who have been
induced to relinquish it after a course of “ water treat-
ment ” rejoice in their emancipation, asserting that
they are fresh.er and freer from catarrhs, &c. Much,
however, must depend on the reactive power of the
individual ; and our army authorities, and Dr. Combe
assert, that even in the tropics — some say especially in
the tropics, flannel is essential.

Most individuals who are braced at water-cure estab-
lishments, or take the hot-air bath, can dispense with
flannel to advantage ; the skin is thus free to breathe and
to exhale its excretions, while the nerves are less petted,
cau died, and spoiled ; but the aged and infirm, who can-
not take exercise, and some whose reaction is weak, and
circulation slow, may find flannel indispensable.

Franklin was in the habit of taking a daily air-bath,
that is, he performed his ablutions and exercises, and
some of his mental labours with his skin, for a consi-
derable time, exposed to the action of the air. This
was a good practice, but how few there are who do not
fear this air-batliing of their skins as a something poi-
sonous— this is especially true with regard to children.

The feet especially must be kept dry and pleasantly
warm ; and young children should be encouraged,
especially in warm weather, to run about the house
without shoes or stockings; they find this a great
luxury. The victims of cold feet might often be cured by

TIIE TREATMENT OF PHTHISIS.

285

walking about briskly in the bouse, or even on the grass,
lawns with naked feet, This advice must appear very
dreadful in the eyes of the good old-fashioned mistresses
of finishing boarding-schools; at which institutions
cold feet and bad digestion are not sufficiently rarely met
with. To the sedentary life and cold feet of boarding-
schools may often be traced uterine disease, if not con-
sumption.

Every morning and evening, from childhood upwards,
the chest should be expanded by the dumb-bell move-
ments, with or without instruments.

The skin should be kept clean and the pores open
by frequent washings with soap and water; the daily
sponging with cold water when it can be borne ; occa-
sionally the warm-water bath, or the hot-air bath.
Some children, however, cannot bear much washing,
becoming thin and weak if the bath is given night
and morning. For girls the skipping-rope should be
used backwards, as this throws back the shoulders, and
expands the chest.

The running, romping, and loud laughing of young
girls is not thought genteel ; and certainly, when papa is
taking his after-dinner nap, is far from being agreeable ;
but, in its proper time and place, it is good for the lungs.

Horse exercise, not in Rotten-row, but out to Rich-
mond, Harrow, &c., is one of the best expanders of the
chest ; and cases are recorded, of daily horse exercise
in the country curing the symptoms caused by advanced
tuberculization. Sydenham considered such exercise a
specific in consumption.

The climbing of hilly roads, -where there is not active
disease, must expand the lungs, and hinder the growth
of tubercle.

286

TIIE LUNGS.

Swimming, of all exercises, is one which brings the
muscles most universally and harmoniously into play,
whilst the back is of necessity rightly curved, and the
lungs fully inflated.

Fencing, single-stick, rackets, cricket, and shooting,
are all excellent exercises for strengthening the lungs.

Hound hand bowling, working as it does especially
on the pectoral muscles, and therefore on the lungs,
must, in moderation, be an excellent exercise.

Rowing, to be of use, must be temperately performed ;
excess in pulling and rowing may be useful exercises for
the exhibition of pluck, but much mischief is often
brought about both to the heart and lungs thereby, and
such exercises at our universities should be under the
control of an educated anatomist and gymnast.

The Swedish exercises of the poet and philosopher
Ling, as introduced into London by Professor Georgii
and Dr. Roth, have the great merit of being under sci-
entific control — uncontrolled physical as well as mental
exercise tending, as it often does, to mere dissipation
[dissipo, to scatter).

But I do not think the mere practice of movements,
systematic or unsystematic, can be regarded as so salu-
tary as the practice of such mental and bodily move-
ments as hilarious out- door games call into play, and I
think it would be well if our professors of movements
taught those Avhich would be called into play if the young
ladies of the present day took part in household works.

Singing, speaking, laughing, reading aloud, and re-
citing aloud, cause a ringing and vibrating in the lungs,
which experience proves to he good for mind and
body.

Of all novels, those of Scott must be regarded as the

TI1E TREATMENT OF niTHISIS.

287

most oxygenated, sunny and breezy, and to read aloud
such^oms at the family circle would not be one of the
least useful exercises for the lungs.

All games which require rapid motion, and induce
an interchange of pleasant thoughts and words, are good,
as compared with the silent, secret, and gambling
games.

One drawback to athletic sports among young men is,
that they too often lead to beer-drinking and excessive
eating — a jollification after a contested game being a
part of John Bull’s system.

The use of the Turkish bath tends to give a distaste
to alcoholic stimulants ; and I am persuaded that if at
our universities the bathers and water-drinkers would
contend with the smoking and beer-drinking section,
the victory in most games where endurance was the
test, would be with the former.

I have thus entered briefly into a subject which
should constitute at least one half of the education of
man, viz., how to strengthen and purify his body, and
render it less prone to disease, and especially to
tubercle.

It is well that Greek, Latin, and mathematics should
be mastered, for even as mere difficulties to be over-
come the discipline must be useful, but a mere accu-
mulation in the memory of words and facts is a mise-
rable substitute for that education which, together with
a pure and strong body, will give a man a generous
heart and a clear, manly, mental vision.

The round-backed, smoking, hollow- chested, dys-
peptic, and tubercular man of letters, can scarcely exer-
cise a healthy influence on the thoughts or actions of
his age — an age which demands that Englishmen at

288

TII E LUNGS.

least shall stand ercJfct on their native shores, it may be
rifle in hand (18G0), examples to all the world of that
which is free, strong, and just.

Curability of Phthisis. — The question of the cura-
bility of phthisis has occupied considerable attention on
the part of pathologists, and has afforded many oppor-
tunities for self-laudation on the part of the credulous
or the pretentious.

According to the experience of Dr. Walshe, at the
Consumption Hospital, about 67 cases in 100 cases
treated were benefited by treatment ; about 33 of his
cases in a limited period grew worse, and died under
treatment, while only 4 in the 100 were restored to
apparent health.

According to M. Louis, two fifths of the cases dying
from all diseases at the Hospital La Charite, discovered
tubercles somewhere on post-mortem examination.

Dr. Rogee found calcareous deposits, viz., decayed
tubercles (?), in one half of the females who died at the
Salpetriere.

Boudet found existing tubercle, or signs of former
tubercle, in about three fourths of the cases examined
at the Paris hospitals.

Post-mortem examination has further frequently de-
monstrated the former existence of tubercular cavities
long healed; and Laennec gives the curious history of
an Englishman having all the signs and symptoms of
phthisis, and who was thought dying, who yet recovered
and lived an unknown number of years, and in robust
health, after coughing up a mass of tubercle the size of
an almond, and, as a consequence, retaining permanent
pectoriloquy.

TIIE TREATMENT OF PHTHISIS.

289

5 Cases also frequently occur in wliicli patients recover
from acute attacks of phthisis, and may survive twenty
or thirty years, and ultimately become again phthisical,
and die.

The inference from these facts is :

1. The existence of tubercle in the lungs or else-
where, in a large proportion of cases, does not produce
fatal results, for whereas tubercle is said to exist in two
fifths, or three fourths of all cases dying at hospitals in
Paris, "only about 25 per cent, of hospital patients die
from tuberculosis.

2. The discovery of calcareous deposits and healed
tubercular cavities demonstrates that active tuberculi-
zation of the lungs is curable, spontaneously or other-
wise.

3. That a 4 per cent, recovery, under circumstances
so favorable as at the Brompton Hospital, is not encou-
raging to the usual line of treatment.

We can only add, that it remains yet to be investi-
gated what proportion of cases would recover under
homoeopathic treatment, aided by the best system of
hygiene.

This at least can be proved, that allopathic treatment
is very unsuccessful, while hospitals, even the best we
have, are not favorable places for the consumptive to
congregate. The massing of any order of diseases
under one roof, and that in a hospital in a densely-
peopled city, is on the face of it a violation of the first
law of hygiene, viz., that pure, undiseased, and undir-
tied air is the first requisite to human life and health.

Facts extracted from the work of Louis. — According
to M. Louis, post-mortem examination of those who

290

TIIE LUNGS.

died of phthisis revealed only 2 of 123 cases in which
tubercle was not found, chiefly at the apex of one or
both lungs ; of these cases, 5 only had tubercle limited
to the left lung, and 2 to the right; and if tubercle existed
throughout the lung, it was usually found to be grey at
the lower part, crude or softened in the middle, while
cavities existed at the apex.

Recent inflammation of variable extent in one or
both lungs and pleurae existed in one tenth of the
cases.

The trachea was softened or ulcerated in one third of
the cases.

The larynx was ulcerated in about one tenth of the
cases.

The pericardium contained a notable quantity of
clear serosity in the tenth part of the cases.

The heart was frequently softened.

The stomach was distended and carried lower down
in one twelfth of the cases.

It was softened or red in one fifth, and was perfectly
healthy in only one fifth of the cases.

The small and large intestines were softened or ulcer-
ated in five sixths of the cases, and perfectly healthy in
only three cases.

The mesenteric glands were tubercular in one fourth
of the cases.

The liver was fatty in one third of the cases, viz., in
ten males and thirty females. But not in the quadru-
mania, dying from phthisis.

The spleen was softened, enlarged, diminished, or
tubercular, in a great many cases.

The kidneys were tubercular in many cases.

The prostate was tubercular in several cases.

BRONCHIAL PHTHISIS.

291

The abdomen contained serous effusion from one to
ten pints in one fourth of the cases.

The araclmoid membrane was thickened and studded
with non-tubercular granulations very frequently. The
lateral ventricles were distended with serous effusion in
three fourths of the cases.

Many of these lesions are common to those cut off by
other diseases, but ulcerations of the larynx, trachea,
epiglottis, and small intestines, and fatty liver, are
almost confined to phthisical cases.

M. Louis also found that when tubercle coexisted in
other organs besides the lungs, tubercle in the lungs had,
with one exception, always advanced further than else-
where, and he says that if after the age of fifteen
tubercle presents itself in any organ, it is almost
certainly, likewise, to be found in the lungs; in 328
cases he found only one exception. This is a fact which
may furnish valuable aid in diagnosis, and hence he says
it warns surgeons to forbear from the removal of tuber-
cular tumours, even although the individual may not
suffer from the symptoms of phthisis — except after very
mature consideration.

BRONCHIAL PHTHISIS.

Bronchial phthisis, viz., tuberculization of the bron-
chial glands “ is an affection almost confined to
children.” In this disease the bronchial glands are
enlarged, and it is generally, but not always, associated
with pulmonary phthisis.

There may be swelled cervical glands, and a congested
aspect, but as children frequently do not expectorate,
blood may not be discovered.

292

THE LUNGS.

There may he a difficulty in swallowing, with harsh
breathing, and a modified voice sound.

There may be excess of vocal fremitus, and dull per-
cussion between the scapulae.

The respiration may be temporarily suppressed if the
tumors be sufficient to impede the entrance of air, and
there may be pectoriloquy over the seat of the tuber-
culous deposit from conduction. The symptoms may
be those of bronchitis with hectic. The cough may be
rough and ringing, and the voice hoarse or inarticulate,
and there may be fits of dyspnoea, and symptoms resem-
bling laryngismus stridulus, and symptoms resembling
pulmonary phthisis, viz. ; hectic sweats, and general
wasting. The little patient gradually sinks, or he may
be suddenly cut off by profuse haemorrhage from per-
foration, it may be, of the pulmonary artery; or he
may be cut off by pneumothorax.

If a scrofulous child have a paroxysmal and chronic
cough, and there be no tubercles at the apices, but a
congested face, and dull percussion between the scapulae,
the most ostensible diagnosis is tuberculization of the
bronchial glands.

The allopathic treatment is the same as for phthisis,
with iodurated applications between the shoulders.

The homoeopathic treatment is also the same as for
phthisis, with cod-liver oil frictions between the scapulae.
Iodine, Spongia, Phosphorus, and Calcaria, may also
be used ; but a long residence at the sea side is much to
be desired, and under the best hygienic circumstances
incipient manifestations of this disease may disappear.

Mediastinal tumors may be tubercular, fibrinous, or
cancerous, or from abscess. If these tumors be small

BRONCHIAL PHTHISIS.

293

they may produce little inconvenience ; but if large, and
they press on the main vessels or bronchi, cough,
dyspnoea, and local and organic congestions may ensue,
presenting symptoms analogous to those of concentric
aortic aneurism, or chronic pericardial effusion, or
enlarged heart.

Tertiary syphilitic deposit in the lungs is a rare
affection, but may produce symptoms analogous to those
produced by tubercular infiltration.

The history of the case, the cachexia, &c., will assist
the diagnosis.

Cancerous infiltration of the lungs, or cancerous
local deposit, will be distinguished from tubercle by the
accompanying cancerous cachexia, while the expecto-
ration will be muco-pus, or like red or black jelly, and
foetid.

Acephalocysts may exist in the lungs, and produce
signs and symptoms closely simulating phthisis.

They may be expectorated in minute fragments, or as
much as a pint at a time has been expectorated.

Dr. Walshe says, “Of nine recorded cases, three only
died from the disease, and five recovered perfectly.”

Acephalocysts have been known to penetrate from
the liver into the lungs, producing violent constitutional
symptoms. Under these circumstances they have been
coughed up tinged with bile, and death has been the
usual result.

APPENDIX.

VENTILATION OF DWELLINGS.

Next in importance to good food is good air. Indeed,
m good air may be said to be of prior importance ; for

while many men can enjoy perfect health either on an
exclusive milk, vegetable, or animal diet, or on a mixed
diet, or, indeed, live for days without food, no good
colour can come to the skin, strength to the mind, or
vigour to the body, unless the individual breathe an
abundant and constant supply of fresh air.

Foul air is the very nourishment of scrofula, typhus,
and other poisons, while fresh air is the very life of
purity and strength.

In a certain building in Glasgow, inhabited by 500
of the working classes, prior to 1832, 100 cases of typhus
occurred annually. This building was then ventilated
by Mr. Fleming, at an expense of £50, and in the eight
following years, instead of 800 cases of typhus occur-
ring, only 4 cases occurred.

In the Dublin Lying-in Hospital, within a certain
period, of 7650 children born, 2944 died within fourteen
days of their birth ; but holes were then made, I believe,
in the window-frames, because the nurses would not
allow the windows to be left open, and the mortality at

VENTILATION OF DWELLINGS.

295

once declined to a proportion which proved that 2000
of the children had been poisoned by bad air.

One night, during 175G, Englishmen, 146 in num-
ber, were shut up in the Black Hole of Calcutta, 18 feet
square, with two small windows on the same side, and
in the morning 123 were found dead and rotten, and 23
only were alive. It is less easy to enumerate, but not
less certain, that thousands and thousands are slain
annually, although gradually, from being shut up in
ill-aired ball-rooms, or within curtains, shutters, and
padded doors in our snug English homes. 1000 cubic
feet, viz., a room 10 feet cube, is given as a good allow-
ance of space to each patient in a hospital ; but, as
Dr. Bence Jones happily puts it, “a fish might enjoy
good health if shut up in a tube through which water
constantly passed over its gills; and so a man might
have abundance of good air, although living in a room
six feet square, if that room were efficiently ventilated;”
the inconvenience being, that small rooms must be
draughty if the air be freely admitted.

The Legislature compels all citizens to remove dust-
heaps, cesspools, and other nuisances from their dwell-
ings ; and if it is so demonstrable that an ill-ventilated
room is a destroyer of health, why does the Building
Act not compel builders to contrive for the ventilation
of those houses which they throw up broadcast over
this great Babylon ?

The Glasgow building holding 500 working people,
I have said, was ventilated at an expense of £50. If
so, why should modern houses, while being built, not
have provision made for ventilation, at an expense say of
£10 or £20 each? The only answer I can find to this
question is, that as houses are now “ run up ” by hun-

APPENDIX.

290

dreds, a few pounds saved on each, at the expense of the
lives of the people, is only “ all in the way of trade/’

In the first volume of ‘The Transactions of the Na-
tional Association for the Promotion of Social Science ’
I have a paper on this subject, in which I propose that
houses should be ventilated by carrying pipes between
the rafters from the centre of the ceiling of each room,
viz., above where the gas or other chandelier hangs,
into a main pipe, which should terminate in an iron
pipe passing up the kitchen chimney. The kitchen
chimney being in operation summer as well as winter,
and on an average, probably, twenty hours out of the
twenty-four, viz., so long as the chimney contains air
warmer than the air of the house or the external air.

In summer, or during warm weather, the best method
of ventilation is the natural method, viz., open windows.
Windows of bedrooms, when the weather is warm,
should be open all night ; and if the individual dislikes
the air blowing on the face, this may be prevented by a
curtain or a screen. Many individuals can bear the
bedroom windows open even in winter nights, and per-
haps all could rejoice in this, if seasoned to it gradually ;
but it certainly does appear that certain individuals have
naturally a very slow reaction against the influence of
cold air or water.

Gas produces, on combustion, sulphurous and car-
bonic acid and ammoniacal vapours, and these, if not
carried off by ventilation, are highly injurious. The
pipe plan, as above proposed, would remedy this ; but
gas could be burned with complete impunity if a bell-
shaped tube were suspended immediately over the
burner, and this tube connected with the pipes, as
above described. This would frequently interfere with

VENTILATION OF DWELLINGS.

297

design ; and certainly there is much room for ingenuity
and taste in the construction of gas-chandeliers. The
vast majority of those now existing are as vulgar and
inappropriate as it is almost possible to conceive.

Gas, if burned slowly, is less injurious than if burned
quickly and imperfectly, and it is therefore good eco-
nomy to burn two or more lights slowly than one
quickly (flaring). The recent invention of a mode-
rating burner prevents the flaring, and is so far good ;
but I believe that one larger apparatus on the same
principle, attached to the supply pipe, would serve the
same end, and would not interfere with design as at
present. Gas is purified at the gas-works, by its being
made to pass through solutions of lime, &c. ; but if
there be a great demand for gas, as in dark weather
especially, there is then no time to purify the gas ade-
quately, and I do not know why individuals should not
have small purifying apparatus attached to their own
supply- pipes.

Gas, as now supplied and as not ventilated, is certainly
much more destructive of air than oil-lamps or candles,
and those with delicate lungs should prefer oil or can-
dles, but gas is so extremely convenient a light, that
we would much desire that it should either be supplied
in much greater purity, or so ventilated as to be
innocuous.

A patent was lately taken out to supply hydrogen gas,
which, being burned inside a cage of fine platinum wire,
this platinum became white hot, and a most beautiful
and perfectly steady light was the result, and as the
combustion of hydrogen could not produce deleterious
gases, watery vapour only being produced, the light
appeared to be most desirable.

298

APPENDIX.

The Great Western Railway terminus and hotel were
to have been so lighted, but, from all I can learn, it
appears that either the cost would be too great, or the
difficulty of making the supply pipes sufficiently tight
(the gas being highly volatile), or some other opposing
interest or reason has deferred the present execution of
the plan.

With regard to Arnott’s chimney ventilation, it should
act well so long as there is a fire burning in the grate ;
but in summer, when there is no fire, and in bed-rooms,
where generally there are no fires, it only makes a flappy
noise, and lets in smoke, and is of no use as a venti-
lator.

So also of the Arnott grate — where the fire burns
from above downwards — it has the merit of producing
less smoke than an ordinary grate ; it is also economical,
and it is not liable to u go out,” but as the fire is vir-
tually a coke fire, the least whiff of coke fumes into the
room, very greatly deteriorates the air of the room. As
now constructed, the open fire-place, notwithstanding
all its waste of fuel and heat, is in a hygienic point of
view the best means of warming and ventilating
rooms which we yet possess, although I cannot
believe that so clumsy a contrivance is to remain the
ultimatum.

Cravats and shirt collars, as worn by men, always
appear to me to act as carbonators of the blood, by in-
terfering with the free circulation between the brain and
the lungs, and may thus be regarded as obstacles to the
free ventilation of the blood.

The hard student in his closet, and the hard rower of
race-boats, alike remove this barrier to free oxygenation ;
but it were better for the man himself that no barrier

COUGH.

299

at any time should be put on the free oxydation of that
blood which goes to refresh and invigorate alike his
body, brain, and thoughts.

COUGH.

In aid of diagnosis it may not be superfluous to enu-
merate the sources from which cough may arise, and
very briefly to describe the anatomy, physiology, and
pathology concerned in the act of coughing.

The parts concerned in the act of coughing are the
diaphragm, the pectoral and abdominal muscles, the
lungs, and the glottis.

The diaphragm is usually said to be the chief agent
in the production of cough by its spasmodic contrac-
tions; but as in another part of this volume I have
given my reasons for believing that the muscular tissue
of the lungs was the chief agent in the act of respira-
tion, so also I believe that coughing and sneezing are
chiefly produced by the spasmodic action of the same
tissue, by which the contained air in the lungs is driven
violently through the glottis, and expelled through the
nose in sneezing, and through the mouth in coughing.

Cough is usually an effort to expel from the lungs
gases or fluids foreign to these organs. For instance,
carbonic acid gas, or even very cold air, if accidentally
inhaled, or phlegm, mucus, or pus, which may be
secreted there in disease.

Cough, however, will be caused by any condition of
things which irritates the lungs, directly or indirectly.
Directly, as in the irritation caused by deposits, as in
tubercle, cancer, or pneumonic consolidation or con-
gestion.

300

APPENDIX.

Indirectly, as in pleuritic irritation.

As the pneumo -gastric and sympathetic nerves are
intimately united, and supply the tonsils, uvula, larynx,
trachea, lungs, heart, liver, and stomach ; and as the
mucous membrane lines continuously the respiratory
and digestive organs ; if any causes of irritation exist in
any of these parts, the pneumo-gastric nerve must re-
ceive intelligence of the fact, and the lungs must sym-
pathise with the condition of things, and thus coughing
must be a very general result — indicating a desire, ex-
pressed more or less loudly, to expel the offending agent
from the body.

The spinal nerves call into action the pectoral and
abdominal muscles to aid in this work. The act of
coughing, as thus excited, is called a reflex act of the
excito-motory system.

So intimate, indeed, are the sympathies of all the
organs of the body, that even the smarting of corns may
be a cause of coughing in a susceptible individual.

The following affections are causes of coughing :

Enlarged, or inflamed, or relaxed tonsils.

Elongated uvula.

Inflamed, ulcerated, or relaxed larynx.

Catarrhal secretions. Influenza.

Bronchitic inflammation, or bronchial secretions.

Congestions of the lungs.

Pneumonia.

Pleurisy.

Tubercle in the lungs.

Pus secreted in the lungs.

Emphysema.

Retarded circulation through the lungs from weak
heart or valvular disease.

COUGH.

301

Aneurism. Enlarged, inflamed, or displaced heart.

(Esophageal irritation.

Indigestion. Gastric inflammation.

Liver inflamed, enlarged, or irritated.

Spleen ditto.

Diaphragm, irritation of, in itself, or from liver or
stomach.

Worms, or intestinal irritation.

Enlargement, displacement, or irritation of the womb,
hence pregnancy cough.

The mere inhalation of cold air is a cause of cough.
Cold applied to the skin, checking skin exhalations, and
thus throwing extra work on the lungs, is the constant
cause of cough in winter.

Piles, or accumulations of hard faeces, are a cause of
cough.

Croup, laryngismus stridulus, measles, smallpox,
hooping-cough, &c., &c.

Teething.

u Old man’s cough ” is generally from a lethargic
state of the circulation through the lungs, and from
bronchial secretions.

Hysterical cough may be from local irritation, from
lcve of sympathy, from habit, or from a hundred causes,
and may be accompanied by hoarseness and loss of
voice.

Cough, as the result of most of the above affections,
has, in this volume, been noticed in treating of these ;
and if we only reflect, that long-continued cough, as in
hysterical or nervous and susceptible individuals, accom-
panied by loss of sleep, pleuritic stitch, and even suspi-
cious emaciation, may be a purely reflex action, we may
not only succeed much better in treating certain ano-

302

APPENDIX.

malous coughs, but will be able the better to quell the
apprehension of those who may continue to cough for
years.

Anomalous dry coughs, by which I mean those which
cannot be accounted for by the symptoms, or by phy-
sical examination, are frequently cured by Nux Vomica,
from the 3° to the 30° dilution, because, as I believe,
that drug is the most active of all known substances in
its power over the excito-motory system.

CLIMATE.

The following brief notes are founded chiefly on
opinions expressed in Sir James Clark's excellent work
on climate.

Penzance is a mild and delightful winter residence,
and possesses beautiful green scenery ; but much rain
falls there, and it is exposed to cold winds in spring.
The winds are often very violent. The climate does
not suit relaxed habits, but it is suitable for those who
like a mild, moist atmosphere, and is suitable for irrita-
ble coughs.

Torquay and Dawlish have climates analogous to
Penzance. Sidmouth is recommended for summer and
autumn, rather than for winter, when it is damp.

Guernsey and Jersey have climates analogous to that
of Penzance.

In the south-west of France, at Nantes, La Rochelle,
Bourdeaux, the climate resembles that of the south-west
of England, but is somewhat milder.

Hastings possesses a mild, although somewhat relax-
ing climate, and is a suitable winter residence. It is
protected from the north and north-east winds, and is
surrounded by fine scenery.

CLIMATE.

303

The south side of the Isle of Wight, viz., Undercliff,
Bonchurch, St. Lawrence, is the finest winter climate
in England. It is nearly as mild as Penzance, and is
less rainy and less relaxing, and as patients can drive or
ride to the east or west side, or on the upper downs, a
more bracing air can be obtained when desired.

Ilfracombe, Linton, Clifton, and Malvern, Aberga-
venny, and Tenby, are mild, yet bracing summer resi-
dences.

Eastbourne, Benrydding, Brsemar, &c., are bracing
residences in summer.

Brighton is a suitable residence in autumn and
winter, mild yet bracing; but, in spring, it is much
exposed to cold winds, and in summer is hot. Nighton,
Cowrs, Shanklin, Hyde, are suitable summer residences.

The south-east of France has a dry, hot, harsh, and
irritating climate, while it is liable to periods of cold
cutting winds. Its climate is, therefore, unsuitable for
the phthisical, but Montpellier or Marseilles might suit
those with relaxed habit and chronic bronchitis. Nice
is good for some cases of chronic bronchitis, having a
bracing climate, but in winter and spring it is subject
to cold, strong winds. Nice is good for scrofulous
children.

Genoa is relaxing in hot weather, and the winds at
other times are cold.

Florence is very cold in winter and spring, and very
hot in summer. Phthisis is a frequently occurring
disease at Marseilles, Genoa, and Florence.

Pau is recommended as a spring residence, but at
Pau chronic rheumatism is said to be almost endemic.

In the Pyrenees are many delightful summer resi-
dences, as at Bonnes and Cauterets.

301

APPENDIX.

Mont d’Or in Auvergne, or V iclii, are also fine summer
residences. It is the practice at Geiss to take a course
of goaPs wliey.

Pisa is mild in winter and spring.

Pome is the most desirable winter residence in Italy.
The climate is mild, though somewhat heavy. Phthisis
is a much rarer disease there than in Florence. Sir
J ames Clark recommends Pome as a winter residence,
in chronic rheumatism, chronic bronchitis, and incipient
phthisis, &c.

At the baths of Lucca a mild summer residence is to
be found, but it is not sufficiently bracing for the majo-
rity of the British race.

Ischia is recommended as a summer residence.

Switzerland would be a delightful summer residence
for an invalid if the sudden changes of temperature and
high winds could be provided against.

Funchal, in Madeira, has a winter climate of about
60°, in summer it is about 80°, with cool winds.
Phthisis is rare among the native population of Madeira,
although hundreds of the consumptives who go to
Madeira are carried off in a few months. Those with
incipient phthisis are enabled to be all day in the open
air, and the majority of such are much benefited by a
residence in the island.

The West Indies are too hot. The discomfort from
insects is also great ; while many negroes die in these
islands of phthisis.

In St. KitPs, Spooner’s Level is 1400 feet above the
sea, and is said to be a paradise on earth, in winter and
spring. In the highland part of Barbadoes, 800 feet
above the sea, the climate is also veiy fine.

Ems, on the Rhine, is a good summer residence.

CLIMATE.

305

Algiers, Egypt, and some parts of Australia, possess
warm and dry atmospheres ; suitable for some forms of
the relaxed habit, and chronic bronchitis.

The climate of Nubia is said to be perfect in winter.

A long sea voyage is popularly believed to be very
advantageous in consumption. The individual being
many hours daily on deck, together with the total
change of life and scene, the constant motion of the
vessel, and it may be the stimulus given to the glandular
system by the sea air, and even by the act of frequent
vomitings, may sometimes lead to very favorable results.

Doubtless long sea voyages have done good when all
other means have failed, and that not only with those
having considerable stamina, but with the very delicate.

In some cases this might be an inducement to emi-
gration to Australia. The discomforts of a long voyage,
and the arriving in a strange and distant land, it may
be without friends, must, however, be well considered.

Travelling for the benefit of health, will almost
always benefit all those who are not too weak to endure
the toil and care accompanying it.

Those who dislike change, who despise all things
foreign, and who growl and grumble at foreigners and
foreign food, beds, and hotels, and who like caudling,
and who “ cannot sleep in strange beds,” are not likely
to be benefited by travelling.

At the best, travelling is cold in winter, and hot and
irritating to all invalids in summer — and what with
passports, hotel bills, and ill-understood foreign lan-
guages, insects, &c., there are annoyances which even
the strong and philosophical cannot always bear with
patience.

306

ArPENDIX.

When travelling it is necessary to eat and drink tem-
perately, as the irregularity of the life, or the change of
food or water, often interfere with the digestion ; while
the sedentary life led during active travelling tends to
constipate the bowels. On arriving at the end of a
journey, if heated and care-worn, a warm bath with
soap and water is an excellent restorative.

The inhabitants of the northern parts of Great
Britain will usually find a sufficiently mild climate when
desired, by removing to the south of England ; while
the inhabitants of the south of England may require a
warmer foreign climate.

In advanced phthisis. Sir J. Clark appears to think
that removal to warm foreign climates rather hastens
than retards the progress of the disease.

Much is said and written against the climate of Great
Britain, yet consumption is not more frequent here than
in some of the finest parts of France and Italy.

This, at least, is certain, that the average duration of
life is greater in this country than in France, Italy, or
Germany ; while I think all will admit that, physically,
the inhabitants of these islands, male and female, are
the finest race in Europe, if not in the world.

THE TURKISH, OR HOT-AIR BATH.

Repeated allusions being made in the foregoing pages
to the hot-air bath, it is necessary that I should give
a brief account of that method of applying heat to the
body in health and in disease.

Many eloquent and elaborate accounts have been
written by the frequenters of the Turkish Bath, an

THE TURKISH OR IIOT-AIR BATH.

307

t: institution ” which appears to instil into its votaries
much enthusiasm.

The Turkish bath, with some modifications, is the
legitimate descendant of the old Homan hath, and those
now existing, especially at Constantinople, are many of
them very splendid establishments.

Briefly stated, the hot-air bath consists of a sweating
room, or two sweating rooms of different temperatures,
heated by flues ; a washing-room, and a cooling-room.
But the sweating-room and wasliing-room may be in
one, while a very excellent substitute for the cooling-
room is to be found, while reclining on a seat in the
open air, as in a garden.

The temperature of the bath is generally from
120° to 1G0°, although as an experiment, and in disease,
a temperature as high as 250° has been submitted to.

The Turkish bath contains some fine steam. In the
hot-air bath there is either no steam or only a very little,
produced by sprinkling a little water on the hot plates
of the flue.

The time the individual remains in the bath is gene-
rally from twenty minutes to one hour ; although in
certain diseases the patient might beneficially re-
main hours in the bath, being occasionally relieved, if
faint, by drinking cold water, or removing for a minute
or two into the cold or open air.

The bath should be taken deliberately and quietly, all
haste being inimical to a favorable result. From one
to two hours are required to take the bath effectually.

After the individual has been sweated sufficiently, he
is usually shampooed, then washed with soap and hot
water, then washed down with tepid or cold wrater, after
which he reposes in the cooling-room.

308

APPENDIX.

Tlie human skin contains about 2,000,000 pores, and
about 30 miles of sweating ducts terminating in these
pores. Normally, if a man take 95 ounces of food and
drink in a day, he will pass off by his lungs about 15
ounces, by his kidneys about 30 ounces, by his bowels
about 10 ounces, and by his skin about 40 ounces. It
is thus evident that the skin is a most important depu-
rative organ.

Further, the skin is composed of an infinitely minute
and sensitive network of nerves and capillaries, and
therefore presents a surface of wonderful extent and
sensibility for the operation of heat and cold.

The main objects of the hot-air bath are — 1. To sti-
mulate the skin, and to sweat out effete matter, and
thus depurate the blood. 2. To relax spasm, or over
tonicity produced by mental or bodily excitement, if
such exist. 3. To restore vigour to the body, bruised
as it were, or exhausted by bodily and mental labour.
4. To draw the blood to the skin, and thus relieve
internal organs of congestion.

By the operation of the sweating process, followed by
washing, the skin is rendered purer than it can possibly
be rendered by the hot water and soap bath. The
glands of the skin are also stimulated by the hot-air
bath, while they are rather relaxed by the hot-water
bath.

The exposure of the skin to the cool fresh air, after
the pores are fully opened by heat, is extremely exhila-
rating and tonic in its action ; and most probably the
direct action of the light and oxygen of the air have on
the freely opened skin further beneficial effects.

The skin is so stimulated by the hot air, that almost
any degree of cold can be borne for some time after-

THE TURKISH OR HOT-AIR BATH.

309

wards, not only without any chance of “ catching cold,”
but with positive pleasure. The writer of this has sat
after a bath in a garden, with his skin freely exposed
for half an hour to the frosty wind of a January morn-
ing, and this with positive pleasure and benefit.

I would not advise the novice, however, to begin with
extremes. He should begin with a temperature about
120°, and remain only so long in the bath as he feels
not faint — and if he have a slow reaction he may feel
disposed at first to shun cold water or cold air after
his bath.

The invalid especially, I believe, should begin care-
fully, although instances in which unpleasant symptoms
have succeeded the bath are quite exceptional.

The votaries of the bath are often enthusiastic in
their admiration of its merits as a regular daily bath,
and assert that they could scarcely endure life with-
out it.

My own experience does not lead me to so enthu-
siastic an admiration; for although I found that a
course of these baths improved my appetite, and in-
creased my flow of spirits bodily and mentally, yet this
result did not continue, and I do not now feel disposed
to take the bath more than once a week.

I believe, however, that the plethoric, and the seden-
tary especially, might take the baths more frequently,
and with advantage ; while I have witnessed many in-
stances of the bath being taken daily with apparently
only good results ; and where such baths can be had at
home, they are doubtless taken with much satisfaction,
especially by those who are easily chilled, and suscep-
tible to coughs, colds, and pleuritic attacks in cold
damp weather.

310

APPENDIX.

I consider the inhalation of pure air, and the exposure
of the body to pure country air, a great desideratum
after the bath, and hence, that much more good will be
derived from such baths in the country or in the
suburbs, than in the centre of the town.

The most perfect ventilation of the hot chamber is
also very important; and if any flaws exist in the
flue, by which carbonic acid, carbonic oxide, or sul-
phurous vapours escape into the chamber, the conse-
quences axe very prejudicial, producing headache and
faintness. Were hot steam pipes used as the heating
means, all effluvia from gases or brick vapour would be
avoided.

The walls and floor of the hot chamber should, if
possible, be such as do not absorb the exhalations from
the body, and such as can be easily washed and kept
sweet. White tiles have been tried ; but such have the
disadvantage of neither absorbing nor radiating heat
readily. They also produce echoing of the voice too
freely. Otherwise the material is very clean and sweet.

Hot water and hot thick steam-baths, appear to me
relaxing, while the hot-air bath is stimulating. In the
treatment of certain forms of disease, the hot-air bath
has this advantage, that it can be borne at a temperature
of 250°, while the thick-steam bath can scarcely be
endured at 115°, or the hot-water bath at 100°.

Hot water, sufficient for even one bath, is further a
difficult thing to obtain in a private dwelling; while
hot water for baths for an entire household is almost an
impossibility. The hot-steam bath has also the disad-
vantage of creating a certain amount of dampness in
a house. There are, however, individuals who take
steam baths with pleasure, but who cannot endure the

THE TURKISH OR HOT-AIR BATH.

311

liot-air baths as now constructed in London ; but then
the hot-air baths, by sprinkling water on the hot bricks
or iron of the flue, can always at pleasure be converted
into a hot Min-steam bath.

The objections offered to the hot-air bath as taken in
health are, that it is unnatural, that it weakens, and
that it causes headache.

But to go into a hot- water bath seems equally unna-
tural. To kill oxen and eat their flesh seems unnatural
on the part of a rational, a spiritual, an immortal being.
Is it not, on the other hand, unnatural to abstain from
cleansing the skin by the best means we possess? We
overclothe the body, and tie it up in close-fitting gar-
ments, carefully shutting out the air; the majority shun
soap and water; and fashion envelopes the body of the
female in a fantastic machine called dress.

Could anything be more unnatural than that the
chief energies of the age should be directed towards
money-making, which, when got, increases the cir-
cumference of man’s anxieties, or procures luxury, or
induces indolence, or begets selfishness, or enslaves
the world to fashion, and all at the expense of health,
and comfort, and happiness ?

When men and women make it a business to find out
and follow nature, they will then be more competent to
pronounce on the naturalness or otherwise of the hot-
air bath.

The entire arrangements of civilised life are more or
less unnatural, and may call for somewhat unnatural
remedies as a compromise.

“ By the sweat of thy brow slialt thou eat bread,”
is the present law of nature. Where this law is not,
or cannot be followed, the artificial sweating produced

312

APPENDIX.

by the bath may sometimes not be a bad substitute.
The bath may disagree with some, and produce weak-
ness and headache ; but thousands of others, after fifty
years' experience, as in Constantinople, have quite
as much faith in its power to refresh and invigorate the
body, as the uncleansed inhabitants of this country
have in beer and cheese, or in Port wine and mutton
chops.

The bath attendants spend ten or twelve hours
daily in the bath, and they are vigorous and healthy
men.

The bath does occasionally produce languor and
headache with beginners, viz., before the skin has
learned to respond freely to the action of the sweating
process. The baths also, as already said, will pro-
duce languor and headache if not sufficiently ven-
tilated.

It is, however, as an agent in the cure of disease,
that I draw attention to the bath in the pages of this
volume.

I believe, that for chronic and acute rheumatism,
and gout, we possess no remedy equal to it ; and if so,
this has a direct bearing on the tendency to heart
disease.

Large quantities of uric acid are sometimes found,
on evaporating to dryness the copious perspiration
poured out of the rheumatic patients, while in the
bath.

For chronic skin diseases, I further believe we have
no remedy equal to the hot-air or hot-steam bath.

The bath has the power of drawing the blood most
actively to the surface, and therefore must be most
useful in all cases of internal congestion.

THE TURKISH OR nOT-AIR BATH.

313

It would, therefore, be most useful in the cold stage
of severe ague, death often resulting, notwithstanding
Quinine, from the congestion of internal organs in this
disease, and especially in the tropics.

The bath is also worthy of trial in all fevers, as in
typhus and scarlet fever.

In tetanus and hydrophobia the higher tempe-
ratures are well worthy of a trial, also in cholera
collapse.

By the power the bath has of deriving to the skin,
it should be very useful in chronic bronchitis, and even
in acute suffocative bronchitis.

The gentle use of the bath should also be very useful
in all cases where the circulation is impeded from
heart disease, and especially in such cases of heart dis-
ease as prevent the patient taking sufficient exercise
to aid the circulation of his blood ; or to obtain the
natural relief from the normally produced skin exhala-
tions.

Congestions of the liver, such as often exist in chronic
bronchitis and heart disease, would also doubtless be
much relieved.

A large number of the phthisical suffer from cold,
and hence eagerly emigrate to warmer climates ; but
the hot-air bath, certainly at least for a time, and many
assert permanently if habitually taken, renders the
skin quite indifferent to changes of temperature. For
those who have the means, and can afford to go abroad,
a residence in a warm climate may be the very best thing
that the incipient consumptive can do. But the great
majority can neither afford the time nor the money to
go and reside in warm climates, and for such, I believe,
the hot-aii’ bath, taken at a moderate heat, would fre-

314

APPENDIX.

quently so stimulate the shin, and so relieve internal
congestions or irritations, that many might not only be
enabled to remain with comfort in this cold, damp, and
changeable climate, but might be thus enabled to take
daily and ample exercise in the open air, and at the
same time enjoy all the comforts of home.

The bath has been established at the Newcastle
Infirmary; and Sir John Fife, physician to the in-
firmary, speaks highly in its favour in skin diseases,
rheumatism, heart disease, and varicose veins.

Hot-air baths have been for some years extensively
used in the establishment of Dr. Barter, at Cork.

Dr. MfLeod has lately fitted up a very spacious one
at Benrydding, where I am told it has become the
favorite part of the establishment.

Dr. Wilson is also, I am told, introducing it at Mal-
vern, and Mr. Smedley at Matlock.

In many respects, indeed, the hot-air bath may be
regarded, if I may use the expression, as the short ivay
to the “ water cure.”

These baths are also extensively used at Manchester
and Sheffield, and are there taken by pugilists and
runners, a sufficient guarantee that they are not found
to be weakening.

In London, several gentlemen have erected these
baths in their own houses ; and, when this can often be
done at an expense of £10 or £20, and when the bath
can be kept in operation for hours, at an expense for
coals of about fourpence; and when we reflect, that by this
means the entire household, viz., servants, masters, and
children, can be kept in a state of surpassing cleanliness ;
while a remedy is always at hand in case of acute dis-
ease, or mere illness, I think the public will soon learn

TI1E TURKISH OR HOT-AIR BATII.

315

that no house should be constructed without provision
for these advantages.

In winter the hot room could not only be used as a
bath, but the entire house could be heated by the same
contrivance.

The early riser in a cold winter morning, after taking
a hot-air bath, could then sit down in comfort to his
studies for hours, enjoying a pleasant glow of mind and
body.

Hot-air baths should certainly be erected at all our
hospitals.

The hot-air bath is so great a luxury that it only
requires to be known to be universally adopted by all
classes. The social and sanitary results it would pro-
duce, especially with the hitherto unwashed classes, are
well worthy of full consideration by all philanthropists ;
while the extreme economy of the hot-air bath should
be considered by all who interest themselves in baths
for the people.*

* Public hot-air baths already exist in London, at 4, Bell Street,
Edgeware Road; 11, Paddington Green; Palace Street, Pimlico; and
42, Somerset Street. And it is further in contemplation to erect at some
convenient place in London, by Joint Stock Company, a large and splendid
establishment. The expense of a bath is from one to five shillings ; but
baths, as a charity, could be given to the poor, if a proper establishment
existed, at an expense of one penny each.

The best account of the Turkish bath is to be found in Mr. Urquhart’s
pamphlet, published by Bryce, Paternoster Row.

31 G

LIST OF MEDICINES

RECOMMENDED IN THIS VOLUME.

DECIMAL DECIMAL DECIMAL

Acid. Nit.

Colchicum.

Manganese c.

Acid. Snip.

* Coffea.

* Mercur. Corr.

Acid. Phos.

* Cobra. Trit.

Mer. Biniod.

* Aconitum.

* Chamom.

* Nux. Vom. 3 & 12.

* Arsenicum. 3 & 12.

Cup. Sulp.

* Opium.

* Aurum.

* Digitalis.

* Puls.

* Argent. Nit.

Drosera.

* Phos.

* Belladonna.

* Ferr. Carb.

* Rhus.

* Bryonia.

Guaiac.

Sabina.

Baryta Carb.

* Hepar.

Sepia.

Bismuth.

* Ilyos.

Silic.

12.

* Bromium.

* Ignatia.

* Spigelia.

* Calcar. Carb.

* Ipecac.

Stannum.

Calcar. Phos.

* Iodium.

Stramonium.

Carb. Veg.

* Kali Bich.

Squilla.

Cannabis.

* Lachesis.

* Spongia.

Cina.

Lobelia.

* Sulph. 3 & 12.

Cocculus.

Lycop.

Veratrum.

* Conium.

Moschus.

Zinc.

* China.

Those marked * are the most important.

INDEX.

Acephalocyst3 in lungs, 293
Air, impure, a chief cause of
disease, 295

Andral, and bloodletting, 12
Aneurism, 91
Angina pectoris, 32
Aorta, diseases of, 90
Arnott, Dr., his grate and ventila-
tor, 298

Arteries, physical signs of, 21
Asthma, 171

Atkin, Dr., and diphtheria, 231
Atrophy of the lungs, 216
Auscultation, 115, 131
Avenbrugger, and percussion, 115

Bath, compressed air, 1 77
„ Turkish, 65, 306
Beilbie, Dr., on croup, 221
Beneke, Dr., on phthisis, 266
Berzelius, and influenza, 169
Black, Dr., on diplitheria, 231,
233

Bretonneau on diphtheria, 233
British youth, character of, 59
Bronchial, phthisis, 291
Bronchitis, acute, 176

Bronchitis, chronic, 162

Cancer of heart, 72
„ of lungs, 293
Churchill, Dr., and the hypophos-
phates of lime in phthisis, 266
Circulation of the blood, author’s
views of, 2
Climate, 273, 302
Coagula in heart, 89
Cocoa, 279
Cold feet, 281-5
Combe, Dr., and hygiene, 2S1
Condy’s disinfecting fluid, 20S,
239

Cough, 299
Cravats, 121

„ impede brain ventilation,
298

Cricket expands chest, 286
Croup, 222

Dietl, and pneumonia, 201
Diet in phthisis, 278
Dilatation of the heart, 60
Diphtheria, 227

Disease : its infallible cure by me-
dicine no boon to man, 116

318

INDEX.

Dress, 283

Dropsy of pericardium, 52

Early rising, 283
Education : wlmt is it ? 287
Elb, Dr., on croup, 225
Elliotson, Dr., on trance, 30

„ on heart murmurs,

Emphysema, vesicular, 217
Empyema, pulsating, 184, 187
Endocarditis, 48
Epps, Dr., and phthisis, 2G6
Evening parties, 278

Fashionable life and tubercle, 281-2
Fatty accumulations about heart,
67

„ degeneration of heart, 69
Fencing, 286
Flannel, question of, 284
Fleischman, Dr., and pneumonia,
200

Friction sounds, 19
Franklin, Benjamin, his air-bath,
284

Gangrene of the lungs, 207
Gas, ventilation of, 296
Gendrin, M., and paracentesis, 185
Grizolle, and pneumonia, 198
Gully, Dr., and indigestion, 279
Gymnastics, Ling’s system, 286

Flail, Dr. Marshall, and syncope, 31
Hand, application of, to chest, 121
Harper, Dr., and paracentesis, 185
Harvey and the circulation of the
blood, 2

Haemoptysis, 209
Haemothorax, 191
Hay asthma, 168
Heart, functions of, 1
„ suction power of, 2
„ physical examination of, 6
„ diseases of, 23
Henderson, Professor, and pneu-
monia, 197

IFering, Dr., and swooning, 31
Hitchman, Dr., and phthisis, 266
Hope, Dr., and bloodletting, 41
Hooping-cough, 171
Hospitals, bad air of, 289
Household work for young ladies,
286

Ilydrothorax, 189
Hypertrophy of heart, 54
Hygiene in phthisis, 280

Induration of the heart, 66
Influenza, 169
Inspection of the chest, 117
Insurance Companies and heart
disease, 80

Junod’s boot in suffocative bron-
chitis, 162

„ in haemoptysis, 214

Kennedy, Mr., and Alpine climb-
ing, 212

Kidd, Dr., on diphtheria, 228, 238

Laennec and auscultation, 115
Ling, the gymnast, 286
Literary men, 287
Liver : author’s theory of its func-
tion, 68, 251, 270

INDEX.

319

Livingstone, Dr , aud African cli-
mate, 275

Louis, and phthisis, 242-5-8, 289
Lungs, function of, 108

„ physical examination of,
114 *

„ diseases of, 153

Madden, Dr., and diphtheria, 231,
238 ‘

Marriage, aim of, 280
Mensuration of chest, 122
Milk diet, 279
Monkeys aud phthisis, 278
Muller, Dr., on phthisis, 2G6
Murmur, organic and inorganic,
diagnosis of, 1 7

Napoleon’s pulse, 6
Nature: her accommodating power
in heart disease, 93
Negroes and phthisis, 275
Nightingale, Miss, 281

(Edema of lungs, 206

Palpitations, 25
Percussion of chest, 125
Pericarditis, acute, 35
„ chronic, 46
Phthisis, 240

„ curability of, 288
Physical signs, summary of, 149
Pleurodynia, 189
Pleuropneumonia of cattle, 204
Pneumonia, 191
Pneumothorax, 189
Pulmonary apoplexy, 215
Pulse, 5, 13, 21, 25, 76

Ramadge on phthisis, 264, 276
Respiration, cause of, 113

„ exercises to increase

power of, 123-4
„ sounds of, in disease,

13G

Respirators, 268

Richardson, Dr., on inunction, 272
Rickets, and oatmeal, 271
Rowing boats, 2S6
Rupture of heart, SG
„ valves, 88
Russell, Dr., and pericarditis, 42

Scott, Sir Walter, type of a healthy
writer, 2S6

Servetus and the circulation of the
blood, 2

Simpson, Dr., and inunction, 271
Singing and reading aloud, 2S6
Snails as a food in phthisis, 271
Softening of the heart, 65
Stokes, Dr., on aneurism, 101, 104
„ on heart murmur, 73

„ aortic constriction, 76

Suckling by phthisical mothers,
2S0

Swimming, 286

Sydenham, and horse exercise, 285
Syncope, 28

Trousseau on diphtheria, 229, 239
Tubercle, description of, 240
„ in heart, 72

„ and moral and physical

degradation, 281

Valsalva’s method in aneurisms,
103

320

INDEX.

Valves, diseases of, 73
„ prognosis in, 80, 82
Ventilation of houses, 2 77, 292

Walshe, Dr., on calcareous expec-
toration, 249

„ diagnosis of phthi-

sis, 258-9

Water cure, 284

Water versus beer, in athletic
games, 287

Wilkinson, Dr., on animal heat, 112
Woollen garments in phthisis, 272

Printed by J. E. Adlard, Bartholomew Close, London.

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